Classifying the severity of paediatric chronic pain – an application of the chronic pain grading

Authors

  • J. Wager,

    Corresponding author
    1. Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
    • German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
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  • T. Hechler,

    1. German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
    2. Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
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  • A.S. Darlington,

    1. School of Medicine, University of Southampton, UK
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  • G. Hirschfeld,

    1. German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
    2. Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
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  • S. Vocks,

    1. Department of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Germany
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  • B. Zernikow

    1. German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
    2. Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
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  • Funding sources

    None.

  • Conflicts of interest

    None declared.

Correspondence

Julia Wager

E-mail: j.wager@kinderklinik-datteln.de

Abstract

Background

The chronic pain grading (CPG), a standard approach to classify the severity of pain conditions in adults, combines the characteristics of pain intensity and pain-related disability. However, in children and adolescents, the CPG has only been validated in a school sample, but not in the actual target population, i.e., clinical populations with pain.

Methods

In the present study, we applied the CPG to a tertiary sample of adolescents with chronic pain (n = 1242). Construct validity, sensitivity to change and prognostic utility were examined.

Results

Results indicate that most adolescents were equally classified into the three higher severity grades. Higher CPG classification was associated with more pain locations, higher pain frequency, longer pain duration, extensive use of health care and more depressive symptoms. Adolescents with a high CPG received recommendations for inpatient treatment more often; however, the prognostic utility for therapy recommendation – as operationalized in this study – was low. Sensitivity to change was assessed via reassessment at follow-up for a subsample of 490 adolescents. The majority of adolescents improved to a less severe CPG; changes were more common in the high severity range.

Conclusion

The CPG may be applied to adolescent tertiary care samples and to assess outcomes in clinical trials. However, in this study it was not appropriate to assign adolescent patients to different treatment options. Future work should focus on developing a comprehensive assessment tool for assigning patients to different treatments.

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