Pediatric Pain Screening Tool (PPST): Rapid identification of risk in youth with pain complaints

Moderate to severe chronic pain is a problem for 1.7 million children, costing $19.5 billion annually in the United States alone. Risk-stratified care is known to improve outcomes in adults with chronic pain. However, no tool exists to stratify youth who present with pain complaints to appropriate interventions. The Pediatric Pain Screening Tool (PPST) presented here assesses prognostic factors associated with adverse outcomes among youth and defines risk groups to inform efficient treatment decision-making. Youth (n=321, ages 8-18, 90.0% Caucasian, 74.8% female) presenting for multidisciplinary pain clinic evaluation at a tertiary care center participated. Of these, 195 (61.1%) participated at 4-month follow-up. Participants completed the 9-item PPST in addition to measures of functional disability, pain catastrophizing, fear of pain, anxiety, and depressive symptoms. Sensitivity and specificity for the PPST ranged from adequate to excellent, with regard to significant disability (78%, 68%) and high emotional distress (81%, 63%). Participants were classified into low (11%), medium (32%), and high (57%) risk groups. Risk groups did not significantly differ by pain diagnosis, location, or duration. Only 2-7% of patients who met reference standard case status for disability and emotional distress at 4-month follow-up were classified as low-risk at baseline, whereas 71-79% of patients who met reference standard case status at follow-up were classified as high risk at baseline. A 9-item screening tool identifying factors associated with adverse outcomes among youth who present with pain complaints appears valid and provides risk stratification that can potentially guide effective pain treatment recommendations in the clinic setting. self-report adaptation STarT Musculoskeletal on the SBST detailed description tool). Consistent with the SBST, the PPST consists of two subscales: Physical and Psychosocial. For all patients are instructed, about the last 2 weeks check your response to the following statements. ” Items 1-8 respondents check “yes” or “no.” All “yes” responses are scored as 1. For item 9, patients check boxes with ratings from “not at all” to “a whole lot. ” The ratings “a lot” and “a whole lot” are scored as 1, whereas the lower ratings of “not at all”, “a little”, and “some” are scored as 0. Summing all items, PPST total scores range from 0 to 9. Psychosocial subscale scores range from 0 to 5 and 0 to 4 for the Physical subscale. The scoring format is identical to the adult screening tool to allow for rapid scoring and risk stratification in a busy clinical setting. curves for PPST total and psychosocial subscale scores against reference standard cases of disability and psychosocial distress. As a screening tool, sensitivity was weighed as more important than specificity. validity. We examined the predictive ability of PPST risk catastrophizing, depression, and anxiety outcomes at 4-month follow-up. We used and one-way ANOVAs to examine differences across the groups based on frequency of reference standard cases and continuous scores at 4-month follow-up. This study introduces a valid screening tool to identify prognostic factors associated with adverse outcomes among youth who present with pain complaints and defines risk groups that can efficiently inform treatment decision-making . The treatment of chronic pain is a challenge. Early identification of patients who present with impairing pain-related comorbidities (e.g., sleep disruption, depressed mood) has the potential to significantly improve the rate of recovery.