Departments of Pediatric Psychology and Pediatric Pain and Palliative Medicine, Helen DeVos Children's Hospital, Grand Rapids, Michigan; Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, Michigan.
Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, Canada.
Am J Prev Med. 2021 Mar;60(3):379-386. doi: 10.1016/j.amepre.2020.08.026. Epub 2020 Nov 5.
Up to 17%-20% of pediatric patients with chronic pain are prescribed opioid pharmacotherapy and face an increased risk of opioid misuse in adulthood. Little is known about the way clinical presentation may influence which children with chronic pain are prescribed opioids. This study examines the associations between child's and caregiver's report of child's pain, physical function, and socioemotional indices with opioid prescriptions in pediatric patients initiating treatment for chronic pain.
Participants were 1,155 pediatric patients (71.26% female, n=823) aged 8-17 years and 1 of their caregivers (89% mothers) who presented for evaluation at a tertiary care pediatric pain clinic. Data were collected from 2015 to 2019 and analyzed in 2020.
Binary logistic regression analyses investigated the relative contribution of child's demographic, pain, and Patient-Reported Outcome Measurement Information System measures to opioid prescription status; separate models were conducted for child's and caregiver's report. Across child and caregiver models, findings were that child's age (older), pain duration (longer; child's report only), and increased physical limitations (mobility challenges and pain interference; caregiver's report only) were the most salient clinical correlates of positive opioid status. Contrary to the existing literature on adults with chronic pain, socioemotional indices (anxiety, depression, peer functioning) were nonsignificant.
A greater understanding of how clinical presentation may relate to prescribed opioid pharmacotherapy informs the field's conceptualization of the sequelae of opioid use and misuse in the context of pediatric chronic pain.
高达 17%-20%的慢性疼痛儿科患者接受阿片类药物治疗，并且在成年后面临更高的阿片类药物滥用风险。对于临床表现如何影响哪些慢性疼痛儿童开具阿片类药物处方，我们知之甚少。本研究探讨了儿童及其照顾者对儿童疼痛、身体功能和社会情感指标的报告与开始慢性疼痛治疗的儿科患者开具阿片类药物处方之间的关联。
参与者为 1155 名 8-17 岁的儿科患者（71.26%为女性，n=823）及其 1 名照顾者（89%为母亲），他们在一家三级儿科疼痛诊所接受评估。数据收集于 2015 年至 2019 年，并于 2020 年进行分析。
二元逻辑回归分析调查了儿童人口统计学、疼痛和患者报告的结果测量信息系统测量值对阿片类药物处方状态的相对贡献；为儿童和照顾者的报告分别进行了单独的模型。在儿童和照顾者的模型中，发现儿童的年龄（较大）、疼痛持续时间（较长；仅儿童报告）和身体功能受限增加（移动挑战和疼痛干扰；仅照顾者报告）是阳性阿片类药物状态的最显著临床相关因素。与慢性疼痛成年患者的现有文献相反，社会情感指标（焦虑、抑郁、同伴功能）不显著。
更深入地了解临床表现如何与处方阿片类药物治疗相关，可以为儿科慢性疼痛中阿片类药物使用和滥用的后果提供更深入的认识。
