Retrospective review of consecutive cases of paediatric complex pain in a New South Wales tertiary children's hospital.

Aim: Prior to July 2013, a solo medical specialist provided a pain management service 1.5-2 days/week to children and young people aged 0-19 years, and their families at John Hunter Children's Hospital, Newcastle, NSW. A new multidisciplinary children's complex pain team now continues that service. This study aimed to identify the demographic and clinical characteristics of children, young people and their families referred to a paediatric pain specialist in the 5.5 years prior to the establishment of a multidisciplinary service and to quantify anecdotal observations, determine service priorities and identify clinical improvement opportunities.

Methods: A retrospective review of the medical records of all new patients seen between January 2008 and June 2013 was conducted. Data sets for patient demographics, clinical characteristics, service outputs and disposition at discharge were determined prior to data extraction.

Results: A total of 114 children and young people aged between 7 days and 18 years (mean ± SD = 12.54 ± 3.6 years) were consecutively referred to the service. Many demographics are consistent with those previously reported; however, the number of children who identified as being of Aboriginal origin (11%), with rare diseases (28%), new diagnoses made (47%), child protection reports submitted (14%) and psychological morbidity in children (58%) and caregivers (38%) are new findings in the context of pain management and serve as indicators of the complex service needs of these patients and their families.

Conclusion: The complexities encountered in this small cohort provide an indication of the time investment needed to understand and manage complex paediatric pain, especially in the contexts of complex families, time-poor general practitioners and under-resourced communities.