6203 Characteristics and management of children with chronic pain referred to tertiary services

Objectives Chronic Pain in children is an undertreated and increasing cause of morbidity, with an estimated prevalence of between 8 and 88% depending on the type of pain.1 2 Biopsychosocial factors are implicated in the development and persistence of chronic pain, including comorbidity, obesity, adverse childhood experiences and socioeconomic status.3–5 The aim of this audit was to characterise the children seen by a tertiary centre chronic pain service and the management options attempted. Methods 100 patients seen in the pain clinic at the Royal Hospital for Children, Glasgow between 2021 and 2023 were audited. Electronic records via clinical portal were used to retrospectively collect data. Data was collected on patient demographics; presenting complaint and primary diagnosis; referrals; management and the social impact of chronic pain. The ICD 11 classification of chronic pain were used to subclassify the patient's diagnosis. Patient postcodes were inputted into the Scottish index of multiple deprivation (SIMD) to gather data on the patients' social circumstances. Results Data was gathered from 100 patients, 67% of the patients were female, 87% were white and 46% were concentrated in the top 30th decile of deprived areas. Of the patients with a documented BMI, 35% were obese. The most common primary diagnosis were chronic primary pain (n=56) and chronic secondary musculoskeletal pain (n=23). 11% had autism spectrum disorder (ASD); a further 8% were awaiting a diagnosis of ASD or ADHD. The average number of referrals to secondary care services was 13 per patient, of which the most referrals were to general paediatrics (n= 93), followed by physiotherapy (n=65) and orthopaedics (n=59). The average number of clinic letters was 31. The modal management was NSAIDs (n=86), with about half of patients being managed with exercise therapy and only 12% receiving psychological therapy. 73% of patients did not have any documentation relating to enquiry about adverse childhood experiences. Financial hardship was only documented in 4% of cases. Conclusion The results demonstrate that a high proportion of patients seen at the paediatric chronic pain clinic are female, awaiting or with a diagnosis of ASD/ADHD (national average 1%) and living in deprived areas. A minority of patients received psychological therapy, despite this being a recommended treatment option,6 7 Furthermore, the results indicate a high burden on the patient and healthcare service as measured by referrals and clinic appointments. Finally, documentation of social factors contributing to chronic pain such as adversity and financial hardship was low. References King, et al. The epidemiology of chronic pain in children and adolescents revisited. 2011. Gobina, et al. Prevalence of self-reported chronic pain among adolescents. 2019. Matthews, et al. Social deprivation and paediatric chronic pain referrals. 2021. Deere, et al. Obesity is a risk factor for musculoskeletal pain in adolescents. 2012. You, et al. Cumulative Childhood Adversity as a Risk Factor for Common Chronic Pain Conditions in Young Adults. 2019. Palermo, et al. Randomized controlled trials of psychological therapies for management of chronic pain in children and adolescents. 2010. https://bnfc.nice.org.uk/treatment-summaries/pain-chronic/