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Waiting for a Pediatric Chronic Pain Clinic Evaluation: A Prospective Study Characterizing Waiting Times and Symptom Trajectories

  • Tonya M. Palermo
    Correspondence
    Address reprint requests to Tonya M. Palermo, PhD, Seattle Children's Research Institute, M/S CW8-6, PO Box 5371, Seattle, WA 98121.
    Affiliations
    Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA

    Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
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  • Margaret Slack
    Affiliations
    Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA
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  • Chuan Zhou
    Affiliations
    Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA
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  • Rachel Aaron
    Affiliations
    Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA

    Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
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  • Emma Fisher
    Affiliations
    Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA

    Centre for Pain Research, University of Bath, Bath, Somerset, United Kingdom
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  • Sade Rodriguez
    Affiliations
    Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA

    Pennsylvania State College of Medicine, Hershey, PA
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Published:October 04, 2018DOI:https://doi.org/10.1016/j.jpain.2018.09.009

      Highlights

      • Access to interdisciplinary pain care is limited for adolescents with chronic pain.
      • There is an unknown impact of the wait list period on adolescents’ pain and function.
      • Little improvement was found in pain and physical, mental, and social health.
      • The qualitative data revealed anxious anticipation and frustration in waiting.
      • Opportunities exist to provide early intervention for youths waiting for evaluation.

      Abstract

      Chronic pain during childhood is prevalent and costly, but the access to interdisciplinary pain care is limited. Studies investigating adults waiting for pain clinic evaluation found that symptoms and quality of life deteriorate over the waiting period, but little is known about the experience of adolescents. Therefore, we aimed to determine wait list times and the longitudinal trends of pain and physical, mental, and social health over a 12-week period. In total, 97 adolescents, aged 10 to 18 years (M = 14.7 years, 82% female), waiting for evaluation at an interdisciplinary pediatric pain clinic completed assessments at enrollment and at 4-, 8-, and 12-week follow-up. We performed a review of the medical record of attendance patterns 12 months later. Twelve adolescents and their parents also completed qualitative interviews, describing their experience of waiting for evaluation. Wait times averaged 197.5 days (range = 69–758 days) from the time of referral to the first-attended appointment, and 86.6% of youths completed appointments. Longitudinal repeated measures analyses demonstrated little improvement in pain or other domains of functioning over the 12-week period. In qualitative interviews, families described anxious anticipation for the upcoming appointment, combined with frustration in waiting. Findings highlight the need to consider approaches to reduce wait times and provide early intervention for youths awaiting pain clinic evaluation.
      Perspective: This study extends the literature on the characteristics and symptom trajectories of adolescents during the wait period for interdisciplinary pain clinic evaluation, described previously only in adults with chronic pain. Findings demonstrated an average wait time of 6.5 months, during which youths’ pain and physical and social health remained impaired.

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