Health Care Utilization and Cost Associated with Pediatric Chronic Pain

Tumin D, Drees D, Miller R, et al.  Pain 2018;159:2050-2057

Reviewed by Sabine Kost-Byerly, MD
Director, Pediatric Pain Management,
Director, Multi-disciplinary Pediatric Pain Clinic, Kennedy Krieger Institute
Associate Professor of Anesthesiology and Critical Care Medicine,
Johns Hopkins University School of Medicine
Baltimore, Maryland

Information concerning the population prevalence of pediatric chronic pain in the United States is limited due to a lack of nationally representative data. Hospitalizations of children with chronic pain have increased, and seem to be prolonged and more costly but other population-based associations between pediatric chronic pain and health care utilization remain poorly defined. This study examines the prevalence of pediatric chronic pain, the associated use of primary care, specialist care, mental health services, CAM, and emergency department (ED) visits, and care-giver reported medical expenditures.

Methods
The study used publically available data collected in the 2016 National Survey of Children's Health (NSCH), a nationally representative cross-sectional paper and web survey directed by the US Health Resources and Services Administration.  In the survey, one randomly selected child per household, ages 0-17 years was eligible for a caregiver-completed questionnaire on physical and mental health, access to health care, insurance status, and sociodemographic characteristics. 

Results
The prevalence of chronic pain based on the survey questions was 6% (2016 NSCH included 50,212 children; 43,712 had sufficient data for the study; 2,874 reported chronic pain). Co-morbidities were common in children with chronic pain: 27% of them had physical, 15% mental health, and 27% had mixed comorbidities. (Children without chronic pain: 18%, 9%, and 7% respectively.) Allergies, heart conditions, anxiety, and depression were associated with increased odds of having chronic pain. Other characteristics associated with higher odds of chronic pain included female gender, older age, lower family income, and fair or poor caregiver-rated health status.  Even though children with chronic pain used more of all services in direct comparison to those without pain, once considering multiple variables, statistically significant odds for increased utilization remained only for specialty care, CAM, and ED visits. Parental higher education was consistently associated with increased likelihood of using health care services except for ED visits. Higher health care costs for children with chronic pain were found to be more likely over the past year.

Conclusion
Based on representative survey data children with chronic pain had higher utilization of CAM, specialty and emergency care. Families also reported higher costs. Limitations of the study included limited data available in children <6 years of age and parental instead of self-report of information provided. (Even though the authors suggest that management of pain in primary care and continued innovation in multidisciplinary pain clinics may improve the efficacy and cost-effectiveness of services, the inadequate pain management training of many primary care providers and the long wait times in tertiary pediatric pain clinics does not offer much hope for the near future.)