Psychosocial dimensions of pain disparities in youth diagnosed with unspecified abdominal pain in an emergency department

Abstract

Diagnosis ambiguity, paired with pain care inequities experienced by marginalized groups may increase risk for ongoing pain and impairment in children diagnosed with unspecified abdominal pain in the pediatric emergency department (PED). This cross-sectional study examined psychological, caregiver, cultural, and socio-ecological factors associated with pain-related impairment in an ethnically and socioeconomically diverse population diagnosed with unspecified abdominal pain in a PED. The sample included 111 children 8–17 years old (59.8 % female, 72.7 % Latinx) and their caregivers. Exclusion criteria included an Emergency Severity Index < 2, psychiatric complaint, or not fluent in English or Spanish. Children completed the PROMIS Pain Interference Scale and reported pain intensity, pain duration, and pain catastrophizing. Caregivers reported language preference, pain catastrophizing, trait anxiety, and child internalizing symptoms. Area Deprivation Index quantified socio-ecological deprivation according to 9-digit zip code. Multivariable logistic regression analyses identified independent associations with likelihood of reporting severe levels of pain-related impairment. Approximately 35.3 % of children reported severe levels of pain-related impairment. In logistic regression analysis, an increased likelihood of endorsing severe pain-related impairment was associated with pain for > 1 month (OR=9.19, p = .044), higher child pain catastrophizing (OR=1.23, p < .001), caregiver Spanish language (OR=11.11, p = .044), and clinically significant caregiver trait anxiety (OR=58.16, p = .004). Results highlight the incidence of severe pain-related impairment in children diagnosed with unspecified abdominal pain in a PED. Moreover, findings underscore the importance of screening pain-related impairment and caregiver anxiety, and addressing language barriers in this PED population.

Perspective

This paper highlights the incidence of severe pain-related impairment among pediatric patients diagnosed with unspecified abdominal pain in a pediatric emergency department (PED). Results could inform early assessment and targeted interventions in the PED to prevent outcome disparities.