Caverius Ulla, Åkerblom Sophia, Lexell Jan, Fischer Marcelo Rivano
Department of Health Sciences, Rehabilitation Medicine Lund University Sweden.
Department of Neurosurgery and Pain Rehabilitation Skane University Hospital Sweden.
Paediatr Neonatal Pain. 2025 Apr 12;7(2):e70005. doi: 10.1002/pne2.70005. eCollection 2025 Jun.
Persistent Pain (PP) in children often has a high impact on their functioning. Knowledge about how to meet the needs is insufficient, especially regarding younger children, children with comorbid psychiatric health conditions, and within different national contexts. A specialized pediatric pain clinic for PP in Sweden offers assessment and interdisciplinary pain rehabilitation (IPR) and collects data on referred children and their parents in a registry. The aims of this study are to (i) describe clinically relevant aspects of children and parents at the first team assessment, (ii) investigate associations between symptoms of psychiatric comorbidity and functioning, (iii) investigate associations between symptoms of ADHD or symptoms of ASD and functioning, and (iv) describe the recommendations after the first team assessment and their rationale. A retrospective cohort study with a descriptive and exploratory design focusing on the characteristics of children ( = 510) and their parents at their first visit for specialized assessment at a tertiary pediatric pain clinic in Sweden between 2013 and 2021. Impairments and complexity appeared to increase with age, with high impact on daily and emotional functioning, especially in relation to symptoms of psychiatric comorbidity and ADHD or ASD. A majority of children and parents were uncertain about the cause of the pain. Only half of the children were recommended IPR, and numerous problems in functioning were found, not only related to pain. In agreement with previous studies describing characteristics of children with PP, there were more girls than boys and older than younger children at the first assessment. Both children and parents report several significant problems in physical, psychological, and social functioning, indicating a need for increased knowledge of PP and care in all kinds of pediatric health care and community settings. Tailored treatment interventions are recommended to improve functioning, including pain education, parental aspects, and addressing psychiatric comorbidities, with a special focus on ADHD or ASD symptoms. More thorough information to referring physicians about evaluations needed before referring to tertiary pain clinics could potentially help set the right expectations for further care and reduce the risk of diagnostic uncertainty.
儿童慢性疼痛（PP）通常对其功能有很大影响。关于如何满足这些需求的知识不足，尤其是对于年幼儿童、患有合并精神健康状况的儿童以及在不同国家背景下的情况。瑞典一家专门针对PP的儿科疼痛诊所提供评估和跨学科疼痛康复（IPR），并在登记册中收集转诊儿童及其父母的数据。本研究的目的是：（i）描述首次团队评估时儿童和父母的临床相关方面；（ii）调查精神共病症状与功能之间的关联；（iii）调查注意力缺陷多动障碍（ADHD）症状或自闭症谱系障碍（ASD）症状与功能之间的关联；（iv）描述首次团队评估后的建议及其理由。一项回顾性队列研究，采用描述性和探索性设计，重点关注2013年至2021年间在瑞典一家三级儿科疼痛诊所首次就诊进行专门评估的510名儿童及其父母的特征。随着年龄增长，损伤和复杂性似乎增加，对日常和情绪功能有很大影响，尤其是与精神共病以及ADHD或ASD症状有关。大多数儿童和父母不确定疼痛的原因。只有一半的儿童被建议进行IPR，并且发现了许多功能方面的问题，不仅与疼痛有关。与先前描述PP儿童特征的研究一致，首次评估时女孩比男孩多，年龄较大的儿童比年龄较小的儿童多。儿童和父母都报告了身体、心理和社会功能方面的几个重大问题，表明在各类儿科医疗保健和社区环境中都需要增加对PP和护理的了解。建议采用量身定制的治疗干预措施来改善功能，包括疼痛教育、家长方面以及处理精神共病，特别关注ADHD或ASD症状。向转诊医生提供关于转诊至三级疼痛诊所之前所需评估的更全面信息，可能有助于为进一步护理设定正确期望，并降低诊断不确定性的风险。
