Adolescents with chronic pain can at times present with disability out of proportion to diagnostic workup. This is also a defining feature of medical child abuse (MCA). The aim of this study was to identify themes from the clinical narratives of adolescents with chronic pain that may indicate concern for MCA. This qualitative, retrospective study at an academic children's hospital between 2011 and 2019 identified 37 adolescents aged 13–18 years old with chronic pain and varying levels of concern for MCA. Conventional, inductive content analysis was used to identify themes from the medical records of all patients, which were reviewed by an interdisciplinary panel of experts. Themes were organised into three tiers related to the level of concern for MCA: ‘Green zone’ themes including fatigue or sleep problems, psychosocial distress, and social withdrawal were common among all patients. ‘Yellow zone’ themes including fragmented care, caregiver catastrophising, caregiver misrepresentation, medical provider exasperation, and sick identity were more common among patients in whom medical providers raised concern for MCA. A single ‘red zone’ theme, reportable harm to the child, was only present in patients diagnosed by a child abuse paediatrician as having MCA. A visual display of the results is provided for further research and clinical application.

中文翻译：

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由于中枢敏化而患有慢性疼痛的青少年对医疗虐待儿童的关注范围

患有慢性疼痛的青少年有时会出现与诊断检查不成比例的残疾。这也是医疗虐待儿童 (MCA) 的一个显着特征。本研究的目的是从患有慢性疼痛的青少年的临床叙述中找出可能表明对 MCA 的关注的主题。这项 2011 年至 2019 年间在一家学术儿童医院进行的定性回顾性研究确定了 37 名 13-18 岁青少年患有慢性疼痛，并对 MCA 存在不同程度的关注。传统的归纳内容分析用于从所有患者的医疗记录中识别主题，并由跨学科专家小组进行审查。主题分为与 MCA 关注程度相关的三层：“绿色区”主题包括疲劳或睡眠问题、社会心理困扰和社交退缩，这些主题在所有患者中都很常见。在医疗服务提供者对 MCA 表示担忧的患者中，“黄色区域”主题更常见，包括支离破碎的护理、护理人员的灾难化、护理人员的虚假陈述、医疗服务提供者的愤怒和患病身份。单一“红色区域”主题（可报告的对儿童的伤害）仅出现在被虐待儿童儿科医生诊断为患有 MCA 的患者中。提供结果的直观显示以供进一步研究和临床应用。