Pediatric Chronic Postsurgical Pain Prevalence, Risk Factors
Presurgical factors that were predictive of chronic postsurgical pain included presurgical pain intensity, child anxiety and pain coping efficacy, and parental pain catastrophizing.
According to a meta-analysis published in the Journal of Pain, an estimated 20% of children have chronic postsurgical pain (CPSP) 12 months after surgery; several presurgical factors predict CPSP in these patients.1
Between 10% and 50% of adults who undergo major surgery report CPSP, which is pain persisting longer than 3 months that is unrelated to preexisting problems or complications from surgery.2 In adults, CPSP has been linked to increased disability, depressive symptoms, and workdays missed. In addition, several biological and psychosocial factors have been identified as presurgical risk factors in this population.3,4
Approximately 50% of children who undergo surgery experience moderate to severe pain while in the hospital, and recent evidence indicates that many of them may continue to have postoperative pain for months or more.5 Although earlier research found worse health outcomes and functional disability in children with CPSP, additional findings on the topic are limited.6 The aim of the current study was to determine CPSP prevalence rates in children (aged 6-18 years) 3 to 12 months after surgery, as well as associated presurgical biopsychosocial risk factors.
Their results show a median prevalence of CPSP of 20% (25th percentile, 14.5%; 75th percentile, 38%) at 12 months postsurgery across all surgery types. Presurgical factors that were predictive of CPSP included presurgical pain intensity, child anxiety and pain coping efficacy, and parental pain catastrophizing. No association was found between the development of CPSP and biological or medical factors.
These findings align with those of previous studies indicating that factors stemming from both children undergoing surgery and their parents underlie the transition from acute to CPSP.7,8 In these patients, the "psychosocial framework also includes the role that parents play in their child's recovery from surgery," the researchers wrote. "Specifically, parents' cognitions and behaviors around their child's pain directly influence their child's experience of symptoms and can influence their child's own pain perceptions and cognitions." For example, parents' anxiety and sleep patterns before their child's surgery have been shown to predict the child's pain intensity 2 weeks postsurgery.9
Many of the studies reviewed had a moderate to high risk for bias and other limitations, highlighting the need for well-designed research with larger sample sizes to further investigate the prevalence and predictors of CPSP in children. "Additional resources and interventions are needed for youth who report persistent pain after surgery," the investigators concluded.
Summary and Clinical Applicability
Approximately 20% of children experience chronic postsurgical pain, which may be predicted by several presurgical parent and child factors.
Few studies met inclusion criteria for the review, and the analysis was limited by the differing criteria that were used to measure pain in the studies.
- Rabbitts JA, Fisher E, Rosenbloom BN, Palermo TM. Prevalence and predictors of chronic postsurgical pain in children: A systematic review and meta-analysis [published online March 28, 2017]. J Pain. doi: 10.1016/j.jpain.2017.03.007
- Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother. 2009;9(5):723-744. doi: 10.1586/ern.09.20
- Hinrichs-Rocker A, Schulz K, Jarvinen I, Lefering R, Simanski C, Neugebauer EA. Psychosocial predictors and correlates for chronic post-surgical pain (CPSP) - a systematic review. Eur J Pain. 2009;13(7):719-730. doi: 10.1016/j.ejpain.2008.07.015
- Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618-1625. doi: 10.1016/S0140-6736(06)68700-X
- Groenewald CB, Rabbitts JA, Schroeder DR, Harrison TE. Prevalence of moderate-severe pain in hospitalized children. Paediatr Anaesth. 2012;22(7):661-668. doi: 10.1111/j.1460-9592.2012.03807.x
- Rabbitts JA, Zhou C, Groenewald CB, Durkin L, Palermo TM. Trajectories of postsurgical pain in children: risk factors and impact of late pain recovery on long-term health outcomes after major surgery. Pain. 2015;156(11):2383-2389. doi: 10.1097/j.pain.0000000000000281
- Connelly M, Fulmer RD, Prohaska J, et al. Predictors of postoperative pain trajectories in adolescent idiopathic scoliosis. Spine. 2014;39(3):E174-81. doi: 10.1097/BRS.0000000000000099
- Page MG, Campbell F, Isaac L, Stinson J, Katz J. Parental risk factors for the development of pediatric acute and chronic postsurgical pain: a longitudinal study. J Pain Res. 2013;6:727-41. doi: 10.2147/JPR.S51055
- Rabbitts JA, Groenewald CB, Tai GG, Palermo TM. Presurgical psychosocial predictors of acute postsurgical pain and quality of life in children undergoing major surgery. J Pain. 2015;16(3):226-34. doi: 10.1016/j.jpain.2014.11.015