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17-04-2013 | Paediatrics | Article

Adult pain grading system applicable in pediatric population


Free abstract

medwireNews: Adult chronic pain grading (CPG) can be applied in pediatric populations and is associated with a higher probability of patients being recommended for inpatient treatment, study results show.

CPG is unable to discriminate between those who will receive inpatient and those who will receive outpatient treatment, however.

"An assessment tool for assigning patients to different treatments may need further detail to fully capture the chronic pain experience," suggest Julia Wager (Witten/Herdecke University, Germany) and colleagues in the European Journal of Pain.

A total of 1242 adolescent patients with chronic pain aged an average 13.6 years participated in the study and completed CPG between July 2005 and June 2010. The CPG took into account factors including average and worst pain intensity, pain location, and pain-related disability, which was defined as school absence.

Participants reported experiencing pain for an average of 2.5 years and the most common site was the head, at 69%, followed by the abdomen, at 16%, then the back and extremities, at 14%.

Just 3% of patients were categorized as having CPG I pain, indicating the least pain intensity and disability. The three subsequent pain grades, CPG II-IV contained an even distribution of patients, with those reporting headaches most likely to be classified as CPG III and those with abdomen pain classified as CPG IV.

Pain frequency increased with increasing CPG grade, with only 1% of CPG I patients reporting constant pain compared with 42% of those with CPG VI.

Wager and co-workers assessed 490 patients who returned for a follow-up appointment within 2-4 months, most of whom reported a reduction in pain severity. For example, 65% of those initially classified as CPG I reported no increase in pain severity, while 38% of those who were initially classified as CPG II reported a decrease in pain.

Recommendations for intensive inpatient treatment were more frequent as CPG increased, at 16% for CPG I patients to 61% of CPG IV patients.

However, area under the receiver operating characteristic curve analysis showed CPG was a poor discriminator between patients who were recommended for inpatient and outpatient treatment, note the study authors.

"Developing an assessment tool for therapy decisions may be a next step," conclude Wager et al.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Sarah Guy, medwireNews Reporter

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