Parental risk factors for the development of pediatric acute and chronic postsurgical pain: a longitudinal study

M Gabrielle Pagé, Fiona Campbell, Lisa Isaac, Jennifer Stinson, Joel Katz, M Gabrielle Pagé, Fiona Campbell, Lisa Isaac, Jennifer Stinson, Joel Katz

Abstract

Background: The goal of this longitudinal study was to examine the associations among psychological factors and pain reports of children and their parents over the 12 month period after pediatric surgery.

Materials and methods: Included in the study were 83 children aged 8-18 years undergoing major surgery. In each case, the child and one of their parents completed measures of pain intensity and unpleasantness, psychological function, and functional disability at 48-72 hours, 2 weeks (child only), 6 months, and 12 months after surgery.

Results: The strength of the correlation coefficients between the psychological measures of the parent and their child increased significantly over time. There was a fair level of agreement between parent ratings of child acute and chronic pain (6 months after surgery) and the child's actual ratings. Parent and child pain anxiety scores 48-72 hours after surgery interacted significantly to predict pain intensity, pain unpleasantness, and functional disability levels 2 weeks after discharge from hospital. Parent pain catastrophizing scores 48-72 hours after surgery predicted child pain intensity reports 12 months later.

Conclusion: These results raise the possibility that as time from surgery increases, parents exert greater and greater influence over the pain response of their children, so that by 12 months postsurgery mark, parent pain catastrophizing (measured in the days after surgery) is the main risk factor for the development of postsurgical pain chronicity.

Keywords: children; pain anxiety; pain catastrophizing; parental risk factors; postsurgical pain.

Figures

Figure 1
Figure 1
Flow chart describing recruitment process. Abbreviations: Cog, cognitive; PACU, postanesthesia care; Develop, developmental.
Figure 2
Figure 2
Squared correlation coefficients between child and parent pain anxiety, pain catastrophizing, and anxiety sensitivity 48–72 hours, 6 months, and 12 months after surgery (upper left quadrant), and child and parent pain anxiety, pain catastrophizing, and anxiety sensitivity scores over the first year are shown in the other three quadrants. Abbreviations: ASI, Anxiety Sensitivity Index; CASI, Childhood Anxiety Sensitivity Index; CPASS, Child Pain Anxiety Symptoms Scale; PASS, Pain Anxiety Symptoms Scale-20; PCS, Pain Catastrophizing Scale; PCS-C, Pain Catastrophizing Scale – Children; SE, Standard error.
Figure 3
Figure 3
Interactions between parent and child pain anxiety 48–72 hours after surgery predict child pain intensity, pain unpleasantness, and functional disability 2 weeks after hospital discharge. Notes: For pain intensity (A) and pain unpleasantness (B), parents with low pain anxiety had children whose pain intensity and pain unpleasantness scores did not differ according to level of child pain anxiety. In contrast, among parents with high pain anxiety, child pain intensity and pain unpleasantness scores were significantly higher in children with high pain anxiety than in those with low pain anxiety. For functional disability (C), children with lower levels of pain anxiety reported similar levels of functional disability regardless of their parents’ pain anxiety scores. Children with higher pain anxiety scores reported higher levels of functional disability if their parents also reported higher compared to lower pain anxiety (C). The interaction between CPASS and PASS is based on continuous variables; the CPASS and PASS were dichotomized using median split for the purpose of illustrating the interaction. Abbreviations: CPASS, Child Pain Anxiety Symptoms Scale measured 48–72 hours after surgery; FDI(2), Functional Disability Inventory measured 2 weeks after discharge from hospital; NRSI(2)t, Numeric Rating Scale for Pain Intensity transformed (square root transformation) measured 2 weeks after discharge from hospital; NRSU(2)t, Numeric Rating Scale for Pain Unpleasantness transformed (square root transformation) measured 2 weeks after discharge from hospital; PASS, Pain Anxiety Symptoms Scale measured 48–72 hours after surgery.

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