Eekelen, FC

Hazebroek-Kampschreur, AJJM

Hunfeld, Joke

Koes, Bart

Passchier, Jan

Perquin, CW (Christel)

Smit, LWA

Wouden, Hans

English

The aim of the study was to determine whether children with chronic benign pain are in contact with their general practitioner (GP) more frequently than those without chronic benign pain. A random sample of children and adolescents aged between 0 and 18 years of age was drawn from the records of ten general practices. According to their responses to a pain questionnaire, subjects were assigned to the chronic benign pain group (n = 95) if they had pain of more than three months' duration, or to the control group (n = 105) if they had pain of less than three months' duration or no pain at all. All the subjects had an average GP consultation rate of 2.6 contacts per year. No significant age and sex differences were found. Chronic benign pain in childhood and adolescence is not related to increased use of healthcare services, suggesting that somatisation does not play a major role in children with chronic benign pain.</p

van Eekelen, Francijna C A

Perquin, Christel W

Hunfeld, Joke A M

Hazebroek-Kampschreur, Alice A J M

van Suijlekom-Smit, Lisette W A

Koes, Bart W

van der Wouden, Johannes C

EUR Research Repository

Brief reportsBritish Journal of General Practice, March 2002 211Francijna C A van Eekelen, Christel W Perquin, Joke A M Hunfeld, Alice A J M Hazebroek-Kampschreur,Lisette W A van Suijlekom-Smit, Bart W Koes, Jan Passchier and Johannes C van der WoudenIntroductionCHRONIC pain is a common complaint in childhood andadolescence. In a recent community survey, one-quarterof children aged between 0 and 18 years reported chronicpain lasting more than three months.1 Many healthcareproviders consider that chronic pain is related to extensivehealthcare utilisation for physically unexplained pain, whichthey often associate with somatisation, although there areno data to support this. The aim of this paper is to determine whether children andadolescents with chronic benign pain consult their generalpractitioners (GPs) more often than children and adoles-cents without chronic benign pain, and whether pain char-acteristics, such as localisation, severity, and persistence,affect the consultation rate.MethodStudy sampleIn March 1998, a 25% random sample of children and ado-lescents aged between 0 and 18 years (n = 1316) wasdrawn from the records of ten GPs in the greater Rotterdamarea.2 Written informed consent to examine the medicalrecords of the children and for participation in a longitudinalsurvey was obtained. After scrutinising the medical records,subjects with chronic pain of known organic aetiology; forexample, owing to rheumatic arthritis and malignancies,were excluded. Subsequently, the group of children withchronic benign pain was invited to participate in a two-yearfollow-up study between May 1998 and May 2000.Instruments and outcome measuresThe subjects or their parents were sent a structured painquestionnaire. They were assigned to the group with chron-ic benign pain if the answer was affirmative to the question:‘Did you/your child experience pain in the previous threemonths?’ and if they also indicated that the pain lastedlonger than three months. The control group consisted ofsubjects who reported pain lasting less than three months orno pain at all. Additional questions concerned the localisa-tion of pain, frequency and intensity of pain, age, sex, andethnicity. Parent ratings were used for subjects agedbetween 0 and 11 years, and self-reporting was used forsubjects aged between 12 and 18 years. This questionnairehas been described in detail by Perquin et al.1The group with chronic benign pain was followed yearlyF C A van Eekelen, medical student; C W Perquin, MD, researchfellow; J A M Hunfeld, PhD, research fellow; B W Koes, PhD,professor; J C van der Wouden, PhD, senior lecturer, Departmentof General Practice; J Passchier, PhD, professor, Department ofMedical Psychology and Psychotherapy, Netherlands Institute ofHealth Sciences, Erasmus University Rotterdam, The Netherlands.A A J M Hazebroek-Kampschreur, MD, PhD, epidemiologist, TheMunicipal Health Service, Rotterdam, The Netherlands. L W A vanSuijlekom-Smit, MD, PhD, paediatrician, Department of Paediatrics,University Hospital Rotterdam, The Netherlands.Address for correspondenceDr J C van der Wouden, Department of General Practice, ErasmusUniversity Rotterdam, PO Box 1738, 3000 DR Rotterdam, TheNetherlands. E-mail: vanderwouden@hag.fgg.eur.nlSubmitted: 19 March 2001; Editor’s response: 4 July 2001; finalacceptance: 21 July 2001. ©British Journal of General Practice, 2002, 52, 211-213.SUMMARYThe aim of the study was to determine whether children withchronic benign pain are in contact with their general practition-er (GP) more frequently than those without chronic benign pain.A random sample of children and adolescents aged between 0and 18 years of age was drawn from the records of ten generalpractices. According to their responses to a pain questionnaire,subjects were assigned to the chronic benign pain group (n = 95)if they had pain of more than three months’ duration, or to thecontrol group (n = 105) if they had pain of less than threemonths’ duration or no pain at all. All the subjects had an aver-age GP consultation rate of 2.6 contacts per year. No significantage and sex differences were found. Chronic benign pain inchildhood and adolescence is not related to increased use ofhealthcare services, suggesting that somatisation does not play amajor role in children with chronic benign pain.Keywords: adolescents; paediatrics; pain.Comparison between children andadolescents with and without chronicbenign pain: consultation rate and paincharacteristicsfor two successive years by means of a posted pain book-let, which consisted of questionnaires on background fac-tors, healthcare use, and quality of life, with a three-weekdiary to record pain.3,4After the follow-up period, the GPs’ medical records of allsubjects were examined to assess the GP consultationrates. All contacts of the subjects with their GP, includinghome visits, consultations and telephone calls, were count-ed. The annual consultation rate over a three-year periodwas calculated, starting one year prior to the survey andincluding the two-year follow-up period. Additionally, the life-time consultation rate was calculated by dividing the totalnumber of contacts by the number of person years. For both groups, the consultation rate, excluding contactsfor chronic benign pain, was also calculated. Chronicbenign pain was defined as pain of unknown organic aetiol-ogy lasting longer than three months, or pain entailing atleast two previous contacts in one year. AnalysisStudent’s t-tests were used to compare means. Linear regres-sion analyses were carried out, with adjustment for age andsex to test the effect of chronic benign pain, and of pain sever-ity and persistence, on the consultation rate. Differences inage-related trends between the groups were tested for inter-action between age (as a continuous variable) and presenceof chronic benign pain by linear regression analysis.Severe chronic pain was defined as chronic benign painwith baseline intensities of more than 50 mm on the VisualAnalogue Scale (VAS) occurring weekly, and persistentchronic pain as chronic benign pain persisting across thetwo-year follow-up period. ResultsRespondersFrom the random sample of 1316 subjects, 123 subjectswere excluded by the GPs because of moving away, lan-guage barriers, and various other circumstances (e.g. termi-nal illness in the family), leaving a study sample of 1193 sub-jects. A total of 819 (69%) questionnaires were completed.Chronic pain was reported by 205 (25%) responders, ofwhom 109 (53%) gave their consent for this study. Althoughnot specifically asked, 105 of the responders without chron-ic pain also gave their consent. Fourteen subjects in thechronic pain group were excluded because the pain was oforganic aetiology (mainly recurrent upper respiratory tractinfections). The average age of the 14 excluded children wassignificantly lower than of the 95 subjects with chronicbenign pain (P<0.001). The group with chronic benign pain(n = 95) comprised 41 boys and 54 girls. The average agefor boys was 11.4 years (SD = 3.8) and for girls 11.1 years(SD = 4.5). The control group (n = 105) comprised 62 boysand 43 girls. The average age for boys was 8.6 years (SD =4.8) and for girls 7.1 years (SD = 5.3). Consultation rateFor both groups the average consultation rate in the three-year period was 2.6 contacts per year (SD = 2.2, median2.0, range = 0–13.7). Table 1 shows the average consultation rate of subjectswith and without chronic benign pain, adjusted for age andsex, during the three-year study period. The group withchronic benign pain and the control group had an equalaverage consultation rate of 2.6 (SD = 1.9) contacts peryear. No age or sex differences were found for the consulta-tion rate. The lifetime consultation rates also showed no sig-nificant differences (data not shown).Of the group with chronic benign pain, 48 (51%) subjectshad contacts with their GP because of chronic benign pain,compared with 14 (13%) in the control group. The averagenumber of these contacts was 2.3 (SD = 1.8) in the groupwith chronic benign pain and 1.5 (SD = 0.9) in the controlgroup. When subjects in the control group with chronicbenign pain contacts were excluded, there were still no sig-nificant differences found for the consultation rates betweenthe two groups. In the group with chronic benign pain, 26 subjects experi-enced severe chronic pain and 20 subjects experienced per-sistent chronic pain. For both subgroups the consultation ratewas 2.5 contacts with their GP per year, which was not signif-icantly different from the control group. Furthermore, no sig-nificant differences were found in the consultation rate for sub-jects with limb pain (34%), abdominal pain (31%), headache(28%), back pain (3%), and other types of pain (4%). DiscussionThese results show that the GP consultation rate was equalfor both groups, and that the average number of GP contactsper year corresponds with the consultation rate of childrenand adolescents from the general Dutch population (2.9 con-tacts per year).5 When the contacts owing to chronic benignpain were included, the consultation rate remained equal forboth groups, suggesting that GPs are not frequently consult-ed for chronic benign pain. Although about half of the chron-ic pain sufferers had contacted their GPs because of chronicbenign pain, the relatively low number of contacts in the sub-jects with chronic benign pain supports this.Although the consultation rate for both groups decreasedwith increasing age, the consultation rate for chronicbenign pain subjects decreased more slowly (Table 1).Unfortunately, the small numbers in this study do not allowfor testing for a difference in age-related trend. Longitudinal212 British Journal of General Practice, March 2002F C A van Eekelen, C W Perquin, J A M Hunfeld, et alHOW THIS FITS INWhat do we know?Somatisation in children and adolescents, particularly in the form of complaints of recurrent pain, is quite common and is related to increaseduse of healthcare services. Although this is not based onevidence, many healthcare providers consider chronic painsufferers to be frequent users of healthcare services.What does this paper add?Chronic benign pain in childhood and adolescence is notrelated to increased use of healthcare services, suggestingthat somatisation does not play a major role in chronic benignpain in children and adolescents.studies are needed to test the hypothesis that tomorrow’sadult chronic pain sufferer has significantly more healthcarecontacts. These results indicate that somatisation does not play amore prominent role in children and adolescents with chron-ic benign pain than in those without chronic benign pain. AcknowledgementThis study was funded by the Netherlands Organisation forScientific Research, grant number 940.31.038.References1. Perquin CW, Hazebroek-Kampschreur AAJM, Hunfeld JAM, et al.Pain in children and adolescents: a common experience. Pain2000; 87: 51-58.2. Middelkoop BJ, Bohnen AM, Duisterhout JS, et al. Rotterdam generalpractitioners report (ROHAPRO): a computerised network of generalpractices in Rotterdam, The Netherlands. Rotterdam’s HuisArtsenProject. J Epidemiol Community Health 1995; 49: 231-233.3. Perquin CW, Hunfeld JA, Hazebroek-Kampschreur AA, et al.Insights in the use of healthcare services in chronic benign pain inchildhood and adolescence. Pain 2001; 94(2): 205-213.4. Hunfeld JAM, Perquin CW, Duivenvoorden HJ, et al. Chronic painand its impact on quality of life in adolescents and their families. JPediatr Psychol 2001; 26: 145-153.5. Centraal Bureau voor de Statistiek. VademecumGezondheidsstatistiek Nederland 1998. ’s Gravenhage: SDU,1998.British Journal of General Practice, March 2002 213Brief reportsTable 1. Annual GP consultation rates during a three-year period, including/excluding contacts for chronic benign pain, for subjects withchronic benign pain and controls by age and sex.Chronic benign pain groupa Control groupaIncluding Excluding Including Excludingchronic benign chronic benign chronic benign chronic benignpain contacts pain contacts pain contacts pain contactsn Mean (SD) Mean (SD) n Mean (SD) Mean (SD)Total 95 2.8 (2.0) 2.6 (1.9) 105 2.7 (2.5) 2.6 (2.5)Age category0–4 years 8 3.1 (2.4) 3.0 (2.4) 32 3.6 (3.1) 3.6 (3.1)5–11 years 44 2.8 (2.0) 2.7 (1.9) 48 2.5 (2.3) 2.5 (2.3)12–18 years 43 2.7 (2.0) 2.5 (1.9) 25 1.7 (1.3) 1.6 (1.3)SexMale 41 2.2 (1.7) 2.1 (1.7) 62 2.5 (2.5) 2.5 (2.5)Female 54 3.2 (2.1) 3.0 (2.1) 43 2.9 (2.5) 2.8 (2.5)aThe distinction between the chronic benign pain group and the control group was made according to subjects’ responses to the pain ques-tionnaire. There are contacts for chronic benign pain in both groups, since chronic benign pain can emerge both before or after the inclusionof responders in the survey. Differences in consultation rates between the two groups, including or excluding contacts for chronic benign pain,were tested by linear regression analyses with adjustment for age and sex, and none were significant.

Comparison between children and adolescents with and without chronic benign pain:consultation rate and pain characteristics

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Comparison between children and adolescents with and without chronic benign pain: consultation rate and pain characteristics

Comparison between children and adolescents with and without chronic benign pain: consultation rate and pain characteristics

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