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Predictors of Referral to a Pediatric Outpatient Chronic Pain Clinic

Tumin, Dmitry, PhD*,†; Miller, Rebecca, BS*; Hakim, Mohammed, MBBS*; Shafy, Shabana Z., MBBS*; Drees, David, MD; Wrona, Sharon, DNP*; Smith, Timothy P., MD*,‡; Tobias, Joseph D., MD*,‡; Bhalla, Tarun, MD, MBA*,‡

doi: 10.1097/AJP.0000000000000664
Original Articles

Objectives: The main objectives of this study were to retrospectively characterize the rate of referrals to an outpatient chronic pain clinic among adolescents with chronic pain, and to identify factors associated with referral.

Materials and Methods: Adolescents, 13 to 18 years of age seen in 2010 to 2015 at outpatient clinics associated with Nationwide Children’s Hospital (NCH) and diagnosed with chronic pain were included if they lived near NCH and had not been previously referred to the NCH outpatient chronic pain clinic. Subsequent referrals to the pain clinic were tracked through December 2017 using a quality improvement database. Factors predicting referral were assessed at the initial encounter in another outpatient clinic and analyzed using multivariable logistic regression.

Results: The analysis included 778 patients (569 female; median age, 15 y), of whom 96 (12%) were subsequently referred to the chronic pain clinic, after a median period of 3 months. Generalized chronic pain (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-3.1; P=0.023) and regional pain syndromes (adjusted odds ratio, 3.1; 95% confidence interval, 1.5-6.7; P=0.003) were associated with increased likelihood of referral. The referral was also more likely among female patients and among patients with a mental health comorbidity or recent surgery or hospitalization.

Discussion: Referrals to our chronic pain clinic were more likely for adolescents with generalized chronic pain, regional pain syndromes, and patients with mental health comorbidities. Recent hospitalization or surgery, but not recent emergency department visits, were associated with pain clinic referral. The multivariable analysis did not find disparities in referral by race or socioeconomic status.

*Department of Anesthesiology and Pain Medicine Nationwide Children’s Hospital

Departments of Pediatrics

Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH

The authors declare no conflict of interest.

Reprints: Dmitry Tumin, PhD, Brody School of Medicine at East Carolina University, 600 Moye Boulevard, Greenville, NC 27834 (e-mail:

Received June 4, 2018

Received in revised form September 22, 2018

Accepted October 1, 2018

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