Highlights
- •The 24-item Children's Somatic Symptoms Inventory total scores were superior to factor scores as indicators of clinical features.
- •Clinical reference groups were derived based on the 24-item Children's Somatic Symptoms Inventory total score tertiles.
- •The high somatic symptom group had the greatest disability and psychological distress.
- •High somatic symptoms corresponded with significantly greater health service use.
Abstracts
Among youth with chronic pain, elevated somatic symptoms across multiple body systems
have been associated with greater emotional distress and functional disability and
could represent poor adaptation to pain. The Children's Somatic Symptoms Inventory
(formerly the Children's Somatization Inventory) is commonly used to assess somatic
symptoms in children. However, no studies have evaluated the clinical usefulness of
the measure in the assessment of pediatric patients with chronic pain. This study
evaluated the factor structure and clinical relevance of the 24-item Children's Somatic
Symptoms Inventory (CSSI-24) in youth (n = 1,150) with mixed chronic pain complaints
presenting to a tertiary pain clinic. The CSSI-24 total scores were equal or superior
to factor scores as indicators of patients’ clinical characteristics (functional disability,
pain catastrophizing, fear of pain, and anxiety and depressive symptoms) and parental
catastrophizing and protective responses. Tertile-derived clinical reference points
for the CSSI-24 total score (<18, low; 19–31, moderate; ≥ 32, high) significantly
differed on measures of clinical characteristics and parent factors. Controlling for
age, sex, pain intensity, and primary pain complaint, the high somatic symptoms group
exhibited significantly greater health care use compared with the moderate and low
groups. The assessment of somatic symptoms in pediatric patients with chronic pain
may provide useful information regarding patients’ psychosocial risk and tendency
to access health services.
Perspective: Clinical reference points based on the CSSI-24 total scores meaningfully
differentiated youth with chronic pain on measures of emotional distress, functioning,
parent catastrophizing and protective responses, and health care use. Assessing somatic
symptoms could provide useful information regarding a pediatric patient's psychosocial
risk, tendency to access health services, and need for enhanced care coordination.
Key words
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Article info
Publication history
Published online: February 13, 2019
Accepted:
February 8,
2019
Received in revised form:
January 9,
2019
Received:
September 6,
2018
Footnotes
Supported by the Sara Page Mayo Endowment for Pediatric Pain Research and Treatment, and the Department of Anesthesiology, Perioperative and Pain Medicine at Boston Children's Hospital. Dr. Stone's effort was supported by Oregon Clinical and Translational Research Institute (OCTRI), grant number TL1TR002371 from the National Center for Advancing Translational Sciences (NCATS) and the Vanderbilt Department of Anesthesiology Clinician Scientist Training in Perioperative Science Fellowship (T32GM108554) from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
The authors have no conflicts of interest to declare.
Identification
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© 2019 by the American Pain Society
