Pediatric Chronic Postsurgical Pain And Functional Disability: A Prospective Study Of Risk Factors Up To One Year After Major Surgery

Brittany N Rosenbloom, M Gabrielle Pagé, Lisa Isaac, Fiona Campbell, Jennifer N Stinson, James G Wright, Joel Katz, Brittany N Rosenbloom, M Gabrielle Pagé, Lisa Isaac, Fiona Campbell, Jennifer N Stinson, James G Wright, Joel Katz

Abstract

Background: Chronic postsurgical pain (CPSP) is a surgical complication associated with increased functional disability, psychological distress, and economic costs. The aims of this paper were to prospectively: (1) examine the incidence of CPSP 6 and 12 months after pediatric major surgery; (2) identify pain intensity and pain unpleasantness trajectories before, and up to 12 months after, surgery; (3) identify pre-operative factors that predict pain trajectory group membership; and (4) identify predictors of 12-month functional disability.

Methods: This study followed 265 children aged 8-17 years at four time points (pre-surgical [T0], in-hospital [T1], 6 [T2] and 12 [T3] months after surgery). Children and parents completed pain and psychological questionnaires. In-hospital physical activity was monitored using actigraphy.

Results and discussion: The incidence of moderate-to-severe CPSP at 6 and 12 months was 35% (95% CI 29.1% to 41.9%) and 38% (95% CI 32.4% to 45.1%), respectively. Three percent (95% CI 1.17% to 6.23%) and 4% (95% CI 1.45% to 6.55%) of children reported using opioids to manage pain at 6 and 12 months, respectively. Growth mixture modeling revealed a two-class trajectory model with a quadratic slope best fit the data for both pain intensity (Bayesian information criterion [BIC] = 3977.03) and pain unpleasantness (BIC = 3644.45) over the 12 months. Preoperative functional disability and cumulative in-hospital opioid consumption predicted pain intensity trajectories. Preoperative functional disability predicted pain unpleasantness trajectories. Preoperative functional disability (OR: 1.05, 95% CI: 1.01 to 1.09) and pain unpleasantness trajectories (OR: 2.59, 95% CI: 1.05 to 6.37) predicted 12-month moderate-to-severe functional disability.

Conclusion: Pre-surgical functional disability is the only factor that predicts both 12-month functional disability and the course of pain intensity and pain unpleasantness ratings over the 12-month period.

Keywords: anxiety; depression; functional disability; pain; parents; pediatrics; surgery; trajectory analysis.

Conflict of interest statement

Joel Katz is supported by the CIHR Canada Research Chair in Health Psychology at York University. Brittany Rosenbloom is supported by a CIHR Canada Graduate Scholarship (CGS) Doctoral Award in Honor of Nelson Mandala. M Gabrielle Pagé was supported by a CIHR Frederick Banting and Charles Best CGS Doctoral Award. The authors report no other conflicts of interest in this work.

© 2019 Rosenbloom et al.

Figures

Figure 1
Figure 1
Participant recruitment and flow through the study.
Figure 2
Figure 2
Predicted pain intensity trajectories.
Figure 3
Figure 3
Predicted pain unpleasantness trajectories.

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