Pain Acceptance as a Predictor of Medical Utilization and School Absenteeism in Adolescents With Chronic Pain.

Objective: Identifying factors contributing to high medical utilization and productivity loss is important, given the high cost of pediatric chronic pain. The current study examined chronic pain acceptance as a predictor of medical utilization and school absenteeism in adolescents with chronic pain.

Methods: In all, 122 adolescents (aged 12-21 years) with chronic pain and their parents/guardians completed questionnaires assessing medical visits (past 6 months), medication usage, and number of school absences (past month). Homebound school status was also reported. Adolescents completed the Chronic Pain Acceptance Questionnaire and pain intensity ratings, and underwent a diagnostic psychological evaluation.

Results: Multivariate generalized linear model analyses indicated lower pain acceptance predicted increased inpatient hospitalizations and higher number of opioid and nonopioid prescription medications, controlling for pain intensity, age, and sex. Pain acceptance was not associated with outpatient consultations or number of nonprescription medications. Exploratory moderation analyses indicated lower pain acceptance significantly predicted increased emergency department visits and inpatient hospitalizations for patients diagnosed with an internalizing psychological disorder. Patients in homebound schooling reported low pain acceptance and for those in school full-time, linear regression indicated lower pain acceptance significantly predicted higher number of school absences.

Conclusions: Findings suggest that lower pain acceptance contributes to the use of higher-level medical care (especially for adolescents with internalizing disorders) and increased productivity loss owing to school absences or homebound school status. Clinical implications exist for recommending acceptance-based interventions for pain acceptance promotion and continued development of cost-effective, easily disseminated acceptance-based therapy modules to curb the economic burden of chronic pain.