COVID-19 Pandemic Impact and Response in Canadian Pediatric Chronic Pain Care: A National Survey of Medical Directors and Pain Professionals

Abstract Background and aims Caring for children with chronic pain incurs burdens of cost and time for families. We aimed to describe variation in caregiver burden among parents of adolescents with chronic pain who responded to a nationally-representative survey. Our secondary aim was to identify child and parent characteristics associated with increased caregiver burden. Methods We used de-identified, publicly-available data from the 2016 National Survey of Children’s Health (NSCH), designed to be representative of non-institutionalized children in the United States. We analyzed data for households where an adolescent age 12–17 years old was reported by a parent to have chronic pain. Outcomes included the parent’s time spent on the child’s health needs, reduced labor force participation, and out-of-pocket medical costs. Results Data on 1,711 adolescents were analyzed. For adolescents with chronic pain, 15% of parents reported spending at least 1 h/week on their child’s health care, 14% reported cutting back on paid work, and 36% reported spending ≥$500 on their child’s health care in the past 12 months. Adolescents’ general health status and extent of specialized health care needs predicted increased caregiver burden across the three measures. Conversely, no consistent differences in caregiver burden were noted according to demographic or socioeconomic characteristics. Conclusions Among adolescents with chronic pain identified on a nationally-representative survey, parents frequently reported reducing work participation and incurring out-of-pocket expenses in providing health care for their child. Caregiver burdens increased with indicators of greater medical complexity (e.g. presence of comorbidities, need for specialized health care) and poorer overall adolescent health status. Implications We add a national-level perspective to studies previously performed in clinical samples addressing caregiver burden in pediatric chronic pain. Initiatives to reduce the burden of caring for children with chronic pain, described in prior work, may be especially beneficial for families with adolescents whose chronic pain is accompanied by other health problems or requires coordination of care among multiple providers.

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Patterns of anxiety symptoms in pediatric chronic pain as reported by youth, mothers, and fathers.

Clinical Practice in Pediatric Psychology ◽

10.1037/cpp0000126 ◽

2016 ◽

Vol 4 (1) ◽

pp. 51-62 ◽

Cited By ~ 17

Author(s):

Susan T. Tran ◽

Kristen E. Jastrowski Mano ◽

Kim Anderson Khan ◽

W. Hobart Davies ◽

Keri R. Hainsworth

Keyword(s):

Chronic Pain ◽

Anxiety Symptoms ◽

Mothers And Fathers ◽

Pediatric Chronic Pain

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Role of Ethnicity on Pain Perception, Fatigue, and Quality of Life in a Pediatric Chronic Pain Population

PsycEXTRA Dataset ◽

10.1037/e691752007-001 ◽

2007 ◽

Author(s):

Jeffrey I. Gold ◽

Trina Haselrig ◽

D. Colette Nicolaou ◽

Katharine A. Belmont

Keyword(s):

Quality Of Life ◽

Chronic Pain ◽

Pain Perception ◽

Pediatric Chronic Pain

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Study Probes Chronic Pain Care in Emergency Department

Family Practice News ◽

10.1016/s0300-7073(05)70804-5 ◽

2005 ◽

Vol 35 (11) ◽

pp. 63

Author(s):

SHERRY BOSCHERT

Keyword(s):

Emergency Department ◽

Chronic Pain ◽

Pain Care

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National Survey: Few Chronic Pain Sufferers See a Specialist

Family Practice News ◽

10.1016/s0300-7073(06)73719-7 ◽

2006 ◽

Vol 36 (16) ◽

pp. 59

Author(s):

ROXANNE NELSON

Keyword(s):

Chronic Pain ◽

National Survey

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Evaluating the Relationship Between Initial Injury, Referral to A Pain Clinic, and Medical Retirement from the Army: A Retrospective Analysis

Military Medicine ◽

10.1093/milmed/usaa463 ◽

2021 ◽

Vol 186 (Supplement_1) ◽

pp. 502-505

Author(s):

Justin J Stewart ◽

Diane Flynn ◽

Alana D Steffen ◽

Dale Langford ◽

Honor McQuinn ◽

...

Keyword(s):

Chronic Pain ◽

Retrospective Analysis ◽

Extended Period ◽

Pain Clinic ◽

Outcome Variable ◽

Future Research ◽

Curvilinear Relationship ◽

The Impact ◽

Pain Care ◽

The Relationship

ABSTRACT Introduction Soldiers are expected to deploy worldwide and must be medically ready in order to accomplish their mission. Soldiers unable to deploy for an extended period of time because of chronic pain or other conditions undergo an evaluation for medical retirement. A retrospective analysis of existing longitudinal data from an Interdisciplinary Pain Management Center (IPMC) was used to evaluate the temporal relationship between the time of initial duty restriction and referral for comprehensive pain care to being evaluated for medical retirement. Methods Patients were adults (>18 years old) and were cared for in an IPMC at least once between May 1, 2014 and February 28, 2018. A total of 1,764 patients were included in the final analysis. Logistic regression was used to evaluate the impact of duration between date of first duty restriction documentation and IPMC referral to the outcome variable of establishment of a permanent 3 (P3) profile. Results The duration between date of first duty restriction and IPMC referral showed a curvilinear relationship to probability of a P3 profile. According to our model, a longer duration before referral is associated with an increased probability of a subsequent P3 profile with the highest probability peaking at 19 months. The probability of P3 declines gradually for those who were referred later. Discussion This is the first time the relationship between time of initial duty restriction, referral to an IPMC, and subsequent P3 or higher profile has been tested. Future research is needed to examine medical conditions listed on the profile to see how they might contribute to the cause of referral to the IPMC. Conclusion A longer duration between initial duty restriction and referral to IPMC was associated with higher odds of subsequent P3 status for up to 19 months. Referral to an IPMC for comprehensive pain care early in the course of chronic pain conditions may reduce the likelihood of P3 profile and eventual medical retirement of soldiers.

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Women Veterans’ Experiences with Integrated, Biopsychosocial Pain Care: A Qualitative Study

Pain Medicine ◽

10.1093/pm/pnaa481 ◽

2021 ◽

Author(s):

Francesca M Nicosia ◽

Carolyn J Gibson ◽

Natalie Purcell ◽

Kara Zamora ◽

Jennifer Tighe ◽

...

Keyword(s):

Chronic Pain ◽

San Francisco ◽

Women Veterans ◽

Self Management ◽

Veterans Health ◽

Health Administration ◽

Care Models ◽

Va Health Care System ◽

Pain Care ◽

Gender Specific

Abstract Objectives Biopsychosocial, integrated pain care models are increasingly implemented in the Veterans Health Administration to improve chronic pain care and reduce opioid-related risks, but little is known about how well these models address women veterans’ needs. Design Qualitative, interview-based study. Setting San Francisco VA Health Care System Integrated Pain Team (IPT), an interdisciplinary team that provides short-term, personalized chronic pain care emphasizing functional goals and active self-management. Subjects Women with chronic pain who completed ≥3 IPT sessions. Methods Semistructured phone interviews focused on overall experience with IPT, perceived effectiveness of IPT care, pain care preferences, and suggested changes for improving gender-sensitive pain care. We used a rapid approach to qualitative thematic analysis to analyze interviews. Results Fourteen women veterans (mean age 51 years; range 33–67 years) completed interviews. Interviews revealed several factors impacting women veterans’ experiences: 1) an overall preference for receiving both primary and IPT care in gender-specific settings, 2) varying levels of confidence that IPT could adequately address gender-specific pain issues, 3) barriers to participating in pain groups, and 4) barriers to IPT self-management recommendations due to caregiving responsibilities. Conclusions Women veterans reported varied experiences with IPT. Recommendations to improve gender-sensitive pain care include increased provider training; increased knowledge of and sensitivity to women’s health concerns; and improved accommodations for prior trauma, family and work obligations, and geographic barriers. To better meet the needs of women veterans with chronic pain, integrated pain care models must be informed by an understanding of gender-specific needs, challenges, and preferences.

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