343: Structural Factors and Referral Pathways Shaping Access to Interdisciplinary Pediatric Pain Care

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Psychology, Non-pharmacological treatments, Treatment/management

Background and Aims: Interdisciplinary pediatric pain programs are geographically limited and primarily situated within specialized academic medical centers in urban settings. Access to specialty pain care is a multistage process shaped by referral pathways, travel burden, and pre-treatment healthcare exposure. Delayed or fragmented access may contribute to higher healthcare utilization and subspecialty-driven care, with pharmacologic or procedural escalation occurring before receipt of coordinated biopsychosocial intervention. This study descriptively characterizes geographic distance, referral source patterns, and pre-clinic treatment exposure among youth evaluated in an interdisciplinary pain clinic to better understand structural factors influencing access and engagement in evidence-based interdisciplinary care.

Methods: We conducted a retrospective chart review of 298 pediatric patients evaluated at an interdisciplinary outpatient pain clinic (pediatric pain physician, psychologist, physical therapist, occupational therapist) in the Southeastern United States. Data were derived from standardized intake assessments. Travel distance was calculated from patient ZIP codes using centroid mapping. Referral source was categorized as subspecialty, primary care, acute care, pain service, or other. Intake questionnaires captured prior medication trials—including nonsteroidal anti-inflammatory drugs, centrally acting neuromodulatory agents (e.g., gabapentin), and opioids—as well as prior procedures and non-pharmacologic therapies. Descriptive statistics characterized geographic distribution, referral pathways, and pre-clinic treatment exposure.

Results: Patients traveled substantial distances to access care (43.5% resided >50 miles from clinic). Referrals were predominantly subspecialty-driven (29.2%), most commonly from orthopedics (10.4%), neurology (6.7%), and rheumatology (4.7%), compared with primary care (3.7%) and acute care sources (1.7%). Prior to evaluation, 39.6% had trialed at least one medication. Most common medications trialed included non-steroidal anti-inflammatory drugs (ibuprofen 85.1%, naproxen 39.0%) and acetaminophen (77.2%), followed by gabapentin (41.9%). The median number of medications previously trialed was 3 (IQR 2–5), and 26.3% had trialed five or more medications; notably, 11.4% reported prior opioid exposure. Physical therapy (68.4%) was common, whereas cognitive behavioral therapy was infrequently trialed (9.1%).

Conclusions: Access to interdisciplinary pediatric pain care is structurally variable and largely subspecialty-driven, with meaningful geographic burden for many families. A substantial subgroup of patients presented to the clinic after pharmacologic escalation (including opioids) and exposure to several interventions (e.g., physical therapy, transcutaneous electrical nerve stimulation, chiropractor) without prior engagement in cognitive behavioral therapy. The relative underutilization of psychological pain treatment suggests delayed integration of coordinated biopsychosocial care. Understanding these pre-clinic pathways may inform strategies to improve retention and engagement, as extensive prior healthcare exposure and mixed messaging may shape expectations and influence pain outcomes and participation in evidence-based, interdisciplinary treatment.

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Palermo, T. M., Slack, M., Zhou, C., Aaron, R., Fisher, E., & Rodriguez, S. (2019). Waiting for a pediatric chronic pain clinic evaluation: a prospective study characterizing waiting times and symptom trajectories. The Journal of Pain, 20(3), 339-347.

Tumin, D., Drees, D., Miller, R., Wrona, S., Hayes Jr, D., Tobias, J. D., & Bhalla, T. (2018). Health care utilization and costs associated with pediatric chronic pain. The journal of pain, 19(9), 973-982.

Hildenbrand, A. K., Amaro, C. M., Bear, B., Soprano, C. M., & Salamon, K. S. (2024). Exploring referral and service utilization patterns within an outpatient interdisciplinary pediatric chronic pain program. Journal of Pain Research, 525-533.

Groenewald, C. B., Law, E. F., Fisher, E., Beals-Erickson, S. E., & Palermo, T. M. (2019). Associations between adolescent chronic pain and prescription opioid misuse in adulthood. The journal of pain, 20(1), 28-37.

Presenting Author: Gloria Han
Submitting Author: Gloria Han

Senior Author: Amanda Stone

IASP 2026 Global Year theme of Neuropathic Pain: No

• Campbell Blake: NA - Vanderbilt University
• Sujanya Narayanan: B.S. - VANDERBILT UNIVERSITY Medical Center
• Lily Bai: B.S. - VANDERBILT UNIVERSITY Medical Center
• Puja Patel: PhD - VANDERBILT UNIVERSITY Medical Center
• Alan Hoang: MD - VANDERBILT UNIVERSITY Medical Center
• Amanda Toye: MD - VANDERBILT UNIVERSITY Medical Center
• Amanda Stone: PhD - VANDERBILT UNIVERSITY Medical Center