Current situation of paediatric chronic pain in Switzerland: prevalence and paediatricians’ experiences. A cross-sectional study

Abstract

<p><i>Background:</i> Chronic pain (CP) prevalence in children and adolescents has been increasing over the past decades. The patient-reported prevalence is around 25% depending on the methodology and location of pain. Chronic pain is defined in this study as persisting or recurrent pain that has lasted longer than three months. <p><i>Objectives:</i> To estimate the prevalence of chronic pain in children and adolescents in Switzerland based on reported number of patients with CP and patient visits in paediatrician practices in primary healthcare, and to investigate the CP care concepts, care provision for CP and professional experiences with chronic pain among paediatricians in Switzerland. <p><i>Methods:</i> Cross-sectional online questionnaire study (languages German, French and Italian) to Swiss paediatricians. <p><i>Questionnaire items:</i> 1. Sociodemographic, work-related characteristics, number of children seen per 3 months in paediatrician practices; 2. Experience with CP, training in CP treatment, comfort with treating patients with CP, estimated prevalence of patients with CP seen, measurement of pain intensity, referral patterns of patients with CP. Descriptive analysis. Prevalence calculations based on number of children with CP seen in the past 7 days and number of total patient visits per 3 months (categorical answers with min., mean and max. values), multiplied to represent the annual total. Multivariate logistic regression analyses on predictors of confidence, experience and training with CP as well as referral. <p><i>Results:</i> 337 participants (participation rate 21%). 20% of the paediatricians feel comfortable and have experience with patients suffering from CP. The same amount report to have training in treating patients with CP. More than two thirds of the paediatricians estimate that less than 5% of their paediatric patient population suffer from CP. The calculated estimated prevalence of CP in paediatric single and group practices in this study is 2.54–3.89%. Almost 80% have referred a patient to a pain ambulatory specialized in children and adolescents. Paediatricians working in hospitals had almost 4 times higher odds of referring a patient compared to those working in a practice. Estimating a higher prevalence of CP in the paediatric population was associated with being trained in CP treatment. Men have 3 times higher odds of feeling comfortable treating paediatric CP. Being experienced in CP gave 11 times higher odds off feeling comfortable with treating CP. <p><i>Conclusion:</i> In this sample of paediatricians, on average 3.35% of patients are identified as patients with CP. The discrepancy to self-reported pain is high. Swiss paediatricians do not feel comfortable with treating CP. Correspondingly they rate their experiences and training low. More focus on educating Swiss paediatricians about CP and information on care options seem necessary.