Identification of pain-related psychological risk factors for the development and maintenance of pediatric chronic postsurgical pain

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

Abstract

Background: The goals of this study were to examine the trajectory of pediatric chronic postsurgical pain (CPSP) over the first year after surgery and to identify acute postsurgical predictors of CPSP.

Methods: Eighty-three children aged 8-18 years (mean 13.8, standard deviation 2.4) who underwent major orthopedic or general surgery completed pain and pain-related psychological measures at 48-72 hours, 2 weeks (pain anxiety and pain measures only), and 6 and 12 months after surgery.

Results: Results showed that 1 year after surgery, 22% of children developed moderate to severe CPSP with minimal functional disability. Children who reported a Numeric Rating Scale pain-intensity score ≥ 3 out of 10 two weeks after discharge were more than three times as likely to develop moderate/severe CPSP at 6 months and more than twice as likely to develop moderate/severe CPSP at 12 months than those who reported a Numeric Rating Scale pain score < 3 (6-month relative risk 3.3, 95% confidence interval 1.2-9.0 and 12-month relative risk 2.5, 95% confidence interval 0.9-7.5). Pain unpleasantness predicted the transition from acute to moderate/severe CPSP, whereas anxiety sensitivity predicted the maintenance of moderate/severe CPSP from 6 to 12 months after surgery.

Conclusions: This study highlights the prevalence of pediatric CPSP and the role played by psychological variables in its development/maintenance. Risk factors that are associated with the development of CPSP are different from those that maintain it.

Keywords: adolescents; anxiety sensitivity; children; chronic postsurgical pain.

Figures

Figure 1
Figure 1
Details of recruitment process. Abbreviation: PACU, post-anesthesia care unit.
Figure 2
Figure 2
Pain intensity (A) and pain unpleasantness (B) scores 6 and 12 months after surgery for children with moderate/severe chronic postsurgical pain. Abbreviations: NRSI, Numeric Rating Scale for pain intensity; NRSU, Numeric Rating Scale for pain unpleasantness.
Figure 3
Figure 3
Differences in pain intensity and unpleasantness trajectories between children with moderate/severe CPSP and without or with mild CPSP. Note: Error bars represent the 95% confidence intervals. Abbreviations: CPSP, chronic postsurgical pain; NRSI, Numeric Rating Scale for pain intensity; NRSU, Numeric Rating Scale for pain unpleasantness; CI, confidence interval.

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