Pediatric Chronic Pain Screening Tool (PCPST): beauty in brevity?

We adapted the Keele STarT Musculoskeletal Screening Tool for pediatric patients and created the Pediatric Chronic Pain Screening Tool (PCPST). The PCPST is designed to guide targeted treatment recommendations for pediatric chronic pain patients based on risk status (high, medium, or low) of poor outcomes using established biopsychosocial prognostic factors. The nine-item measure includes questions about the presenting pain complaint, disability, catastrophizing, fear, and depression. Among children (n=71) aged 8-17 who presented for initial evaluation at our tertiary care pain clinic we examined the cross-sectional distribution of scores and risk stratification to determine PCPST construct validity in relation to reference standard measures of pain-related psychosocial functioning. Scores were normally distributed and ranged from 0 to 9 with a Mean of 4.4 (SD=2.2). The PCPST stratified 38% of patients as low-risk, 25% as medium-risk, and 37% as high-risk. The PCPST risk strata differentiated clinical cut-offs for pain-related fear (68% of low-risk in low-fear group, 73% of high-risk in high-fear group) and depressive symptoms (81% of low-risk in low depressive symptom group, 80% of high-risk in high depressive symptom group). Lastly, PCPST scores were highly correlated with child functional disability (r=.54, p<.01), pain-related fear (r=.65, p<.01), pain catastrophizing (r=.69, p<.01), and depressive symptoms (r=.62, p<.01). Altogether, the PCPST shows great promise as a brief tool to screen for biopsychosocial risk. The robust overlap of risk stratification and clinical cut-offs with pain-related fear and depressive symptoms and high correlations with psychosocial questionnaires provide substantive evidence for the construct validity of this brief tool. The PCPST is a brief prognostic screening tool which demonstrates cross-sectional validity which may potentially aid in clinician decision-making in providing targeted interventions. Further research is required to determine predictive validity, use in monitoring patient progress, and the clinical effectiveness of stratified care approaches among this population.