Psychiatric disorders in children and adolescents presenting with unexplained chronic pain: what is the prevalence and clinical relevancy?

Abstract

The prevalence of psychiatric disorders among children with unexplained chronic pain (UCP) is high in unselected populations and pain clinics, yet the clinical relevance of these disorders in children referred for unexplained pain is not known. This study assessed the prevalence of clinically relevant psychiatric disorders and their predictors in children referred to a children’s hospital for UCP. Psychiatry morbidity was assessed in 134 children, aged 8–17 years, using the Diagnostic Interview Schedule for Children–parent version (DISC-P) and the Semi-structured Clinical Interview for Children and Adolescents (SCICA). Clinical relevance was determined using a maladjustment criterion of 61 or lower on the Children’s Global Assessment Scale (CGAS). Pain parameters were measured with standardized questionnaires. Results were analysed by logistic regression. According to the DISC-P, 21% of the children had clinically relevant psychiatric disorders, predominantly anxiety disorders (18%). According to the SCICA, 28% of the children had clinically relevant psychiatric disorders, consisting of anxiety, affective, and disruptive disorders (12, 19, and 9%, respectively). Headache (compared to musculoskeletal pain) was an independent clinical predictor of psychiatric morbidity (OR = 3.10; 95% CI 1.07–8.92, p = 0.04/adjusted OR 2.99; 95% CI 1.02–8.74, p = 0.04). In conclusion, clinically relevant psychiatric disorders are common among children and adolescents referred for UCP. Adding a child psychiatrist assessment, treatable affective and disruptive disorders become identifiable. Children with an additional risk are those presenting with headache.

Functional Abdominal Pain in Childhood and Long-term Vulnerability to Anxiety Disorders

“…This study extends the literature linking pediatric FAP to anxiety disorders 7,10,11,50 with prospective data showing that patients with FAP continue to experience high rates of anxiety disorders into adolescence and young adulthood. Patients with FAP also had high rates of depressive disorders during their lifetime, but few met criteria for a depressive disorder at the time of follow-up.…”

Chronic Daily Headache in Children and Adolescents

“…In a Japanese study, children with CDH and school phobia had significantly more psychiatric disorders (including adjustment, anxiety, and conversion) that those without school phobia [50]. All these observations have been confirmed in a number of clinic-based studies [6••] and in a study of unexplained chronic pain [51].…”

The risk of overlooking risks

“…The original study presented by Knook et al [7] illustrates the relevance of a joint paediatric and childhood psychiatric approach, previously described in 2006 [8], to detect psychiatric morbidity in children and adolescents initially referred to paediatric departments and outpatient clinics. They assessed psychiatric disorders and their predictors in children and adolescents with unexplained chronic musculoskeletal or abdominal pains or headache (UCP).…”