The epidemiology of outpatient pain treatment in pediatrics

BACKGROUND: There is limited real-world, population-level data on the prevalence and treatment of pain in children. An understanding of pediatric pain conditions and its management can help inform provider education, treatment guidelines, and design of pediatric pain studies. Therefore, in this study, we aimed to describe the prevalence of conditions associated with acute and chronic pain in pediatric patients and to characterize pediatric pain treatment with nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 (COX-2) inhibitors, opioids (immediate release or extended release), antidepressants, topical analgesics, anticonvulsants, and other therapies based on a large, real-world sample. MATERIALS AND METHODS: In this cohort study, we used administrative claims data from the Truven Health MarketScan(®) Research Databases, which contain data regarding demography, prescription, diagnosis, and procedure performed. Descriptive statistics were used to assess the prevalence of various conditions associated with pediatric pain and to estimate the proportion of patients who received various analgesic and nonanalgesic treatments. All analyses were stratified according to demographics. RESULTS: This study included data on more than 30 million pediatric patients from throughout the US. Overall, among patients with commercial insurance, surgery was the most common pain-related diagnosis, followed by orthopedic conditions, malignancies, trauma, and genetic conditions. For patients with Medicaid, surgery was also the most common diagnosis, followed by traumatic injury, orthopedic conditions, malignancies, and genetic conditions. These diagnoses varied by age, with most showing higher prevalence in older children. Treatment varied substantially by condition, and many children (more than 50% for most of the conditions evaluated) did not receive any prescription pain treatments. For patients with either commercial insurance or Medicaid who were using prescription opioids, immediate-release opioids were the most commonly used analgesic treatment for pain. Overall, prescription pain treatments were more common in the Medicaid population. Extended-release opioids were rarely used. CONCLUSION: The types of pain treatments varied substantially by condition and age of the patient, with the highest prevalence of use in older children.