Interdisciplinary management of paediatric chronic and complex pain: the experience of a specialised outpatient clinic in Italy

Purpose: This study aimed to describe the structure, patient characteristics, and preliminary clinical outcomes of a dedicated interdisciplinary outpatient clinic for paediatric chronic and complex pain in Italy, with a focus on the feasibility of implementing a biopsychosocial care model. Methods: We conducted a retrospective review of all patients referred to the Paediatric Specialised Pain Clinic of the University of Padua between January 2023 and May 2024. Data on demographics, clinical diagnoses, pain characteristics, treatments, and follow-up outcomes were collected. Results: A total of 34 patients (mean age 12.5 years; 56% female) were evaluated over 67 consultations. The most common clinical conditions among patients with pain included musculoskeletal disorders, sickle cell disease, and complex regional pain syndrome. Neuropathic pain accounted for 11% of cases, while the majority (64%) presented with complex pain phenotypes. Treatment plans combined lifestyle interventions, psychological and physical therapies, and-in selected cases-scheduled pharmacological treatments such as gabapentinoids and opioids. A multimodal approach led to ≥ 50% pain reduction in all but one patient lost to follow-up. Conclusion: Our findings support the feasibility and clinical relevance of a structured, interdisciplinary paediatric pain clinic for managing chronic and complex pain. While most paediatric pain can be addressed in non-specialist settings, a subset of patients with complex, disabling pain requires multimodal care within a dedicated interdisciplinary service. This model may represent a scalable prototype for the implementation of paediatric pain services in other regions of Italy and comparable healthcare systems. What is known: • Chronic pain affects more than 20% of children and adolescents. Despite its high prevalence, it is still frequently underrecognized and undertreated, with significant consequences for the overall well-being of the child and family. • Interdisciplinary and biopsychosocial approaches are recommended internationally but remain limited in availability. What is new: • A structured, multimodal care pathway combining pharmacological and non-pharmacological interventions was feasible even in a regional setting, with ≥ 50% pain reduction in most patients. • It is crucial to develop and evaluate new care models specifically designed to address complex pain conditions that remain unresolved within primary or secondary care services.