Seattle Children's Hospital, Safe Child and Adolescent Network (SCAN), 4800 Sand Point Way NE, Seattle, WA 98105, United States; University of Washington School of Medicine, Seattle, WA, United States.
Seattle Children's Research Institute, 1915 Terry Ave, Seattle, WA 98101, United States.
Child Abuse Negl. 2022 Oct;132:105788. doi: 10.1016/j.chiabu.2022.105788. Epub 2022 Jul 21.
Both medical child abuse (MCA) and central sensitization (CS) may present in adolescents with chronic pain, disability, high healthcare utilization, and unremarkable medical evaluations.
This study aimed to identify themes in the clinical narratives of adolescents with chronic pain that may help differentiate MCA from CS.
Participants were 28 adolescents (ages 13-18 years) with chronic pain referred to either the Child Abuse Pediatrics team or the Pediatric Pain Medicine team at a tertiary children's hospital between 2011 and 2019, and diagnosed with MCA or CS, respectively.
This was a qualitative, retrospective study. Qualitative themes were derived through a process of inductive content analysis utilizing open coding, grouping, and secondary review by an interdisciplinary panel of experts. The relative prevalence of each code, theme, and overarching category was examined between groups to identify areas of convergence and divergence.
Several themes appeared to be more prevalent in the MCA group (n = 9) compared to the CS group (n = 19). These included sick identity, homeschooling, caregiver with mental health disorder, maternal catastrophizing, maternal misrepresentation, persistence in healthcare-seeking, mandated reports made, medical neglect, and unnecessary and harmful medical care.
This exploratory work identified themes from the clinical narratives of adolescents with chronic pain that may help differentiate MCA from CS. A visual reference, two illness scripts, and management recommendations are presented to aid pediatric providers in facilitating appropriate referrals for adolescents with chronic pain and disability out of proportion to diagnostic workup.
在患有慢性疼痛、残疾、高医疗保健利用率和无明显医学评估的青少年中，可能同时存在医源性儿童虐待（MCA）和中枢敏化（CS）。
本研究旨在确定慢性疼痛青少年临床叙述中的主题，这些主题可能有助于将 MCA 与 CS 区分开来。
参与者为 28 名患有慢性疼痛的青少年（年龄 13-18 岁），他们在 2011 年至 2019 年期间分别被转诊到一家三级儿童医院的儿童虐待儿科学组或儿科疼痛医学组，被诊断为 MCA 或 CS。
这是一项定性、回顾性研究。通过使用开放式编码、分组和由跨学科专家小组进行二次审查的归纳内容分析，得出定性主题。在组间检查每个代码、主题和总体类别相对流行率，以确定趋同和分歧的领域。
与 CS 组（n=19）相比，MCA 组（n=9）中似乎有几个主题更为常见。这些主题包括病态身份、在家上学、照顾者有心理健康障碍、母亲灾难化、母亲错误陈述、坚持寻求医疗保健、强制报告、医疗忽视和不必要和有害的医疗保健。
这项探索性工作从患有慢性疼痛的青少年的临床叙述中确定了可能有助于将 MCA 与 CS 区分开来的主题。本文提供了一个视觉参考、两种疾病脚本和管理建议，以帮助儿科医生为慢性疼痛和残疾程度不成比例的青少年提供适当的转介，超出了诊断范围。
