ORIGINAL ARTICLE

Children with unexplained chronic pain: substantial impairment in everyday life

A Y Konijnenberg², C S P M Uiterwaal⁴, J L L Kimpen², J van der Hoeven³, J K Buitelaar⁵, E R de Graeff-Meeder¹

¹ Dept of Psychiatry, University Medical Centre Utrecht, Netherlands
² Dept of General Paediatrics, University Medical Centre Utrecht, Netherlands
³ Dept of Child and Adolescent Psychiatry, University Medical Centre Utrecht, Netherlands
⁴ Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands
⁵ Dept of Psychiatry and Academic Centre for Child and Adolescent Psychiatry, UMC St Radboud, Nijmegen, Netherlands

Correspondence to:
Dr E R de Graeff-Meeder
University Medical Centre Utrecht, Department of Psychiatry, A00.241, PO Box 85500, 3508 GA Utrecht, Netherlands; e.deGraeff-Meeder{at}wkz.azu.nl

Aims: To describe and quantify impairment in an outpatient population of children with chronic pain of unknown origin (UCP).

Methods: A total of 149 children who presented with pain of at least three months’ duration and without a satisfactory explanation at presentation were studied. Number of somatic complaints (Children’s Somatisation Inventory, CSI), pain intensity (VAS, 0–10 cm), functional disability (Child Health Questionnaire (CHQ-CF) and clinical history), and general health perceptions (CHQ) were determined.

Results: Mean age of the children was 11.8 years; 73% were girls. Overall, 72% suffered impairment in sports activities, 51% reported absence from school, 40% experienced limitations in social functioning, and 34% had problems with sleeping. Mean number of somatic symptoms differed significantly between boys (8.4) and girls (10.7). The CHQ-CF scores for physical functioning, role/social functioning, and general health perceptions were 76.4, 70.7, and 57.5, respectively, indicating substantial impairment on all domains. The mean pain intensity was 4.7 for current and 7.1 for worst pain. Children solely evaluated by a general practitioner prior to referral reported less, though still substantial, impairment. Low general health perceptions, impaired role/social functioning, high pain intensity, and having headache or musculoskeletal pain were independent predictors of having significant impairment.

Conclusions: Referred children with UCP show substantial impairment on multiple domains in daily life.

Abbreviations: CHQ-CF, Child Health Questionnaire Child Form; UCP, unexplained chronic pain; CSI, Children’s Somatisation Inventory; C group, the group of children referred by a consultant physician or surgeon; GHP, General Health Perceptions (scale CHQ-CF); GP group, the group of children solely evaluated by their general practitioner prior to referral; PF, Physical Functioning (scale CHQ-CF); PPQ, Pediatric Pain Questionnaire; PUC study, Pain of Unknown origin in Children Study; RP, Role and Social Functioning (scale CHQ-CF); VAS, Visual Analogue Scale

Keywords: pain; chronic disease; quality of life; functional disability

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