Social deprivation and profile of referrals and disability in paediatric chronic pain: a cross-sectional study
Authors: Matthews Eveline , Muldoon Maeve , O’Keeffe Norma , McCarthy Kevin 
Published: February 2020

AbstractSocial deprivation is associated with a higher prevalence of chronic pain in children and an under-representation in specialist paediatric chronic pain programs. This study is a retrospective, cross-sectional analysis of referrals to the National Paediatric Complex Pain Service in Ireland to assess if there is any link between social deprivation and pattern of referrals. Secondary objectives included determining any additional differences between deprivation categories and pain characteristics, parental pain catastrophizing, and pain-related disability, including sleep quality and school attendance. We recorded data on 289 children referred to the NPCPS between February 2016 and November 2019. Social deprivation was assessed using the Pobal HP Deprivation Index, which is based on Irish national census data. The results of the primary analysis showed referrals have a normal distribution across the deprivation index, although the disadvantaged group had a longer duration of pain at time of first clinic review (p=0.01). Secondary analyses showed deprivation is associated with higher levels of parental pain catastrophizing (p=0.0016), most significantly for helplessness (p=0.0009), and higher use of screens at bedtime (p=0.002) with longer sleep onset latency (p=0.04). However, there were similar rates of sleep disturbance, school attendance, social interference across the deprivation groups. These findings may indicate inequities in access or differences in service utilization for children from socially disadvantaged families. The differences in sleep hygiene and parental pain catastrophizing may indicate the need to screen for these potential mediators of treatment outcome, which may require targeted intervention when present, in order to harmonise treatment responses across deprivation grades.Research in contextEvidence before this studySocial deprivation is associated with an increased risk of chronic pain in childhood, however children from deprived areas may be under-represented in specialist paediatric pain centres. This is be due to inequities in access to services and also differences in healthcare utilisation, possibly due the cognitive burden of poverty.Added value of this studyThis study found that while referrals were normally distributed across social deprivation grades, children from the disadvantaged group had pain for longer prior to their first clinic review. This may indicate differences in healthcare utilisation by disadvantaged families. Additionally, we found differences in sleep hygiene and parental pain catastrophizing, which are both of these are known mediators of pain chronicity.Implications of all available evidenceDue to potential differences in healthcare utilisation across deprivation grades, clinical pathways might need adaptation for disadvantaged families for greater efficacy.Targeted interventions that address sleep hygiene and parental catastrophizing might also be considered early in a treatment pathway for disadvantaged families, perhaps with more scheduled follow-up, to harmonise treatment responses across deprivation grades.