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Vandeleur DM, Cunningham MM, Palermo TM, Groenewald CB. Association of Neighborhood Characteristics and Chronic Pain in Children and Adolescents in the United States. Clin J Pain 2024; 40:174-181. [PMID: 38013473 PMCID: PMC10922713 DOI: 10.1097/ajp.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To determine the associations between neighborhood characteristics and chronic pain during childhood and adolescence in the United States, 2020-2021. METHODS Cross-sectional analysis of the 2020 and 2021 National Survey of Children's Health. National Survey of Children's Health grouped parents' responses to questions about neighborhood characteristics into 5 categories: neighborhood support, neighborhood safety, school support, neighborhood amenities, and the presence of detracting neighborhood elements. Chronic pain was defined as parents reporting their children had "frequent or chronic difficulty with repeated or chronic physical pain, including headache or other back or body pain during the past 12 months." Multivariable Poisson regression analyses estimated associations between neighborhood characteristics and chronic pain, adjusted for sociodemographic characteristics. RESULTS The sample contained 55,387 children (6 to 17 years), weighted to represent 44 million nationally. Children had significantly increased rates of chronic pain if they lived in neighborhoods that were unsupportive, unsafe, had unsafe schools, fewer amenities, and greater numbers of detracting elements ( P <0.0001). After adjusting for covariates, children had significantly increased chronic pain if they lived in neighborhoods that were not supportive (adjusted prevalence rate ratio=1.7 (95% CI: 1.5-1.9, P <0.0001), with similar patterns observed for living in neighborhoods characterized as not safe, that did not have safe schools, with fewer amenities, and/or more detracting elements. DISCUSSION Disadvantageous neighborhood characteristics are associated with pediatric chronic pain prevalence. Future research should investigate the underlying mechanisms of this association and guide neighborhood interventions aimed at preventing and decreasing childhood chronic pain and its associated burdens.
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Affiliation(s)
- Daron M. Vandeleur
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Maia M. Cunningham
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
| | - Tonya M. Palermo
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Cornelius B. Groenewald
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
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Hildenbrand AK, Amaro CM, Bear B, Soprano CM, Salamon KS. Exploring Referral and Service Utilization Patterns Within an Outpatient Interdisciplinary Pediatric Chronic Pain Program. J Pain Res 2024; 17:525-533. [PMID: 38333433 PMCID: PMC10849913 DOI: 10.2147/jpr.s430411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/21/2023] [Indexed: 02/10/2024] Open
Abstract
Purpose We examine referral sources and clinical characteristics for youth presenting to an outpatient interdisciplinary pediatric chronic pain program. Patients and Methods Referral data were extracted from the electronic health record. PROMIS Pediatric Anxiety and Pain Interference Scales were administered at an initial evaluation visit. Results The program received 1488 referrals between 2016 and 2019, representing 1338 patients, with increasing volume of referrals over time. Referrals were primarily from orthopedics (19.6%), physical medicine and rehabilitation (18.8%), neurology (14.4%), and rheumatology (12.6%). Patients referred were primarily female (75.4%), White (80.1%), English-speaking (98.4%) adolescents (median=15.0 years). Of those referred, 732 (54.7%) attended an interdisciplinary evaluation (ie, with ≥2 disciplines). Adolescent anxiety was within the expected range by self-report (N=327, MT-score=55.67) and parent proxy-report (N=354, MT-score=57.70). Pain interference was moderately elevated by self-report (N=323, MT-score=61.52) and parent proxy-report (N=356, MT-score=64.02). There were no differences between patients referred who attended versus did not attend an interdisciplinary evaluation based on age, sex, ethnicity, or language. A smaller than expected proportion of referred Black patients (44%, P=0.02) and patients referred from orthopedics (40%) or pulmonology (11%) attended an evaluation, whereas a larger than expected proportion of those referred from physical medicine and rehabilitation (78%) were evaluated (P<0.001). Conclusion Results highlight the demand for outpatient interdisciplinary pediatric chronic pain treatment. Findings can inform decisions related to staffing and service design for pediatric hospitals that aim to establish or grow outpatient pediatric chronic pain programs.
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Affiliation(s)
- Aimee K Hildenbrand
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
- Division of Behavioral Health, Nemours Children’s Hospital Delaware, Wilmington, DE, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christina M Amaro
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Benjamin Bear
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, USA
| | - Catherine M Soprano
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Division of Diagnostic Referral, Nemours Children’s Hospital Delaware, Wilmington, DE, USA
| | - Katherine S Salamon
- Division of Behavioral Health, Nemours Children’s Hospital Delaware, Wilmington, DE, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Hess CW, Rosen MA, Simons LE. Looking inward to improve pediatric chronic pain outcomes: a call for team science research. Pain 2023; 164:690-697. [PMID: 36637136 PMCID: PMC10879964 DOI: 10.1097/j.pain.0000000000002836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/22/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Courtney W. Hess
- Stanford University School of Medicine; Department of Anesthesiology, Perioperative, & Pain Medicine
| | - Michael A. Rosen
- Johns Hopkins University School of Medicine; Department of Anesthesiology and Critical Care Medicine
| | - Laura E. Simons
- Stanford University School of Medicine; Department of Anesthesiology, Perioperative, & Pain Medicine
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Salamon KS, Carlson M, Hildenbrand AK. Who Gets Referred? A Pilot Study of Risk Stratification and Treatment Referral in Pediatric Headache Using the Pediatric Pain Screening Tool. J Pediatr Psychol 2021; 47:403-411. [PMID: 34757430 DOI: 10.1093/jpepsy/jsab117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Headaches are common among youth and are associated with significant negative outcomes. Despite advances in interdisciplinary treatments for youth with chronic pain, research suggests disparities in access to these services. METHODS A total of 186 youth (M = 14.19 years old, 70.8% female) presenting to a neurology appointment at a children's hospital system were screened using the Pediatric Pain Screening Tool (PPST), a brief, validated measure to identify youth that may benefit from additional pain management services. RESULTS Two-thirds of participants (n = 124, 66.7%) screened as medium or high risk on the PPST. Risk categorization did not vary by patient age or sex. A greater proportion of Hispanic/Latino patients were categorized as low-risk relative to non-Hispanic/Latino patients (55.6% vs. 30.1%), and a somewhat lower proportion of patients of color were categorized as medium-risk relative to White patients (14.0% vs. 30.5%). Three-quarters (n = 94, 75.8%) of patients who were screened as medium or high risk were not referred for any additional pain management services. Referrals did not vary by patient age or ethnicity. While not statistically significant, a lower proportion of males received referrals at both medium (8.3% vs. 17.6%) and high levels of risk (15.8% vs. 34.5%), and a greater proportion of youth of color who screened as medium risk received referrals relative to White youth categorized as medium risk (37.5% vs. 10.3%). CONCLUSION Future research should continue to explore factors influencing decision-making regarding referral to specialized pain management services for youth with headache.
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Affiliation(s)
- Katherine S Salamon
- Division of Behavioral Health, Department of Pediatrics, Nemours/A. I. duPont Hospital for Children, USA
| | - Megan Carlson
- Division of Behavioral Health, Department of Pediatrics, Nemours/A. I. duPont Hospital for Children, USA.,Center for Healthcare Delivery Science, Nemours Children's Health System, USA
| | - Aimee K Hildenbrand
- Division of Behavioral Health, Department of Pediatrics, Nemours/A. I. duPont Hospital for Children, USA.,Center for Healthcare Delivery Science, Nemours Children's Health System, USA
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Patterns of Health Insurance Coverage and Lung Disease Progression in Adolescents and Young Adults with Cystic Fibrosis. Ann Am Thorac Soc 2021; 18:290-299. [PMID: 32885982 DOI: 10.1513/annalsats.201911-839oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Rationale: Health insurance coverage has been implicated as a socioeconomic factor affecting clinical outcomes in patients with cystic fibrosis (CF), but evidence for this is mixed and varies by age.Objectives: Focusing on adolescents and young adults with CF, we examined how multiyear patterns of health insurance coverage were associated with lung function decline and related outcomes.Methods: We used data from the 2000 to 2015 CF Foundation Patient Registry to classify patients in three cohorts (ages 12-17 yr, adolescents; 18-23 yr, transitioning to adulthood; and 24-29 yr, young adults) according to health insurance coverage, as follows: continuous private, continuous public, intermittent public, and coverage gaps. The primary outcome was the percentage predicted forced expiratory volume in 1 second (FEV1pp), which was modeled using mixed-effects regression. Additional outcomes included outpatient visits, hospital days for pulmonary exacerbation treatment, bacterial colonization, and body mass index. Outcomes were assessed over a 6-year period (e.g., ages 12-17 yr), whereas exposures were assessed over the prior 6 years (e.g., ages 6-11 yr).Results: The three cohorts included 3,365, 2,800, and 1,807 patients, respectively. The highest rate of FEV1pp decline was found in the middle cohort, with the annual decline being steeper among patients with continuous public (-3.1/yr; 95% confidence interval [CI], -3.3 to -2.8) or intermittent public (-2.4/yr; 95% CI, -2.6 to -2.2) coverage compared with patients with continuous private coverage (-2.1/yr; 95% CI, -2.2 to -2.0). These differences were not explained by differences in outpatient care utilization.Conclusions: During the transition to adulthood, use of public insurance was associated with accelerated lung function decline among patients with CF. The role of insurance as a causal factor in this decline or proxy for other socioeconomic characteristics should be explored in further studies.
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Boppana SS, Miller R, Wrona A, Tumin D, Wrona S, Smith TP, Bhalla T, Kim SS, Tobias JD. Barriers to Outpatient Pediatric Chronic Pain Clinic Participation Among Referred Patients. Clin Pediatr (Phila) 2020; 59:859-864. [PMID: 32425071 DOI: 10.1177/0009922820922847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Initial clinic evaluation among referred patients and factors limiting treatment initiation are not well characterized. We conducted a retrospective review of referrals to our outpatient pain clinic to identify intake visits and factors associated with treatment initiation among adolescents with chronic pain. We identified adolescents aged 13 to 18 years at the time of referral to clinic (2010-2016). Factors associated with completion of visits were evaluated using logistic regression. Patients who completed visits more frequently had private insurance than public or no insurance (P = .053). The most common reasons for caregiver decision not to attend the pain clinic included use of another pain clinic, that services were not wanted or no longer needed, and that their child was undergoing further testing. The current study demonstrated that patients with head pain were more likely to complete an intake visit, while there was a trend showing that lack of private insurance decreased this likelihood.
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Affiliation(s)
| | | | - Aubrey Wrona
- Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Sharon Wrona
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Timothy P Smith
- Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | - Tarun Bhalla
- Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
| | | | - Joseph D Tobias
- Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University, Columbus, OH, USA
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Memarian S, Pawlowski C, Tumin D, Jose FA, Jamison SD. Primary care pediatricians' use of specialty referrals in treating children with chronic abdominal pain. Int J Adolesc Med Health 2020; 34:205-209. [PMID: 32829313 DOI: 10.1515/ijamh-2020-0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/14/2020] [Indexed: 11/15/2022]
Abstract
Objectives Pediatric chronic abdominal pain (CAP) is typically managed in primary care settings, although specialty referrals may help patients access the full range of biopsychosocial treatment options. We investigated patterns of specialty referral (gastroenterology or mental health) among children with CAP seen in an academic pediatric primary care clinic. Methods We retrospectively identified patients age 4-17 years visiting our primary care clinic in 2016-2017 for abdominal pain, identified using International Classification of Diseases (ICD) codes. We excluded patients whose symptoms did not persist for 3 months or who were referred to a specialist before their symptoms had persisted for 3 months. Referral outcomes were assessed through December 2018. Results Of 320 patients with qualifying ICD codes, 253 were excluded because their symptoms did not persist for 3 months; 31 had already been referred to a specialist within 3 months of pain onset; and one chart could not be accessed. Of the remaining 34 patients (22/12 girls/boys, median age 10 years) 10 (29%) were referred to a gastroenterologist and none were referred to mental health specialists. No clinical or demographic factors reached statistically significant associations with gastroenterology referral, although pain duration was shorter among patients who were referred. Conclusions Children with CAP managed in our primary care clinic were seldom referred to specialists after their pain persisted over 3 months. Increasing focus on cognitive-behavioral therapies for chronic pain, and the low specialty referral rate, indicates that primary care practices should be prepared to offer these treatment modalities to children with CAP.
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Affiliation(s)
- Shadman Memarian
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Callie Pawlowski
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Folashade A Jose
- Department of Pediatric Gastroenterology and Hepatology, Atrium Health, Charlotte, NC, USA
| | - Shaundreal D Jamison
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
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