<p>A Conceptual Model of Biopsychosocial Mechanisms of Transition from Acute to Chronic Postsurgical Pain in Children and Adolescents</p>

Abstract

Acute and chronic pain are highly prevalent and impactful consequences of surgery across the lifespan, yet a comprehensive conceptual model encompassing biopsychosocial factors underlying acute to chronic pain transition is lacking, particularly in youth. Building on prior chronic postsurgical pain models, we propose a new conceptual model of biopsychosocial mechanisms of transition from acute to chronic postsurgical pain. This review aims to summarize existing research examining key factors underlying acute to chronic postsurgical pain transition in order to guide prevention and intervention efforts aimed at addressing this health issue in children. As pain transitions from acute nociceptive pain to chronic pain, changes in the peripheral and central nervous system contribute to the chronification of pain after surgery. These changes include alterations in sensory pain processing and psychosocial processes (psychological, behavioral, and social components), which promote the development of chronic pain. Patient-related premorbid factors (eg, demographic factors, genetic profile, and medical factors such as premorbid pain) may further modulate these changes. Factors related to acute injury and recovery (eg, surgical and treatment factors), as well as biological response to surgery (eg, epigenetic, inflammatory, and endocrine factors), may also influence this process. Overall, longitudinal studies examining temporal pathways of biopsychosocial processes including both risk and resiliency factors will be essential to identify the mechanisms involved in the transition from acute to chronic pain. Research is also needed to unravel connections between the acute pain experience, opioid exposure, and sensory pain processing during acute to chronic pain transition. Furthermore, future studies should include larger and more diverse samples to more fully explore risk factors in a broader range of pediatric surgeries. The use of conceptual models to guide intervention approaches targeting mechanisms of transition from acute to chronic pain will significantly advance this field and improve outcomes for children and adolescents undergoing surgery.

Do Parental Pain Knowledge, Catastrophizing, and Hypervigilance Improve Following Pain Neuroscience Education in Healthy Children?

“…In conclusion, a single 45 min session of PNE4Kids was associated with a significant increase in parental pain knowledge as well as a significant decrease in parental proxy reports about their child's fear of pain in the short term. Based on these results, this type of intervention could be a strategy to prevent the transition from acute pain to chronic pain in children, given that a child's pain experience is related to parental anxiety or magnification thoughts about pain [13,14]. To the best of our knowledge, this is the first study examining the parental response to a PNE program targeting young, healthy children (8-12 years).…”

“…Thus, PNE might contribute to more adequate coping with future pain situations and might minimize the transition from acute pain to chronic pain, given that emotions, cognitions, and behaviors related to pain are among the wide variety of risk factors for this transition [13,14]. Indeed, a child's pain experience has been found to be related to the child's fear of pain and previously developed pain memories, as well as to parental anxiety or magnification thoughts about pain [2,15].…”

Extending the biopsychosocial conceptualisation of chronic post surgical pain in children and adolescents: The family systems perspective

“…Chronic postsurgical pain (CPSP) is defined as pain located in the region of the surgery, where alternative causes such as infection or malignancy have been excluded; pain that persists for three months or longer; and where there are impacts on quality of life. 3 , 4 Estimates of the prevalence of CPSP in pediatric populations vary, but in general the 12-month postoperative rates are in the range of 20% 5 , 6 to approximately 40%. 7 , 8 Considering that each year close to 4 million surgeries are carried out on children aged 0 to 17 years in the United STates alone, 9 the size of the problem cannot be underestimated.…”

A pilot feasibility and acceptability study of an Internet-delivered psychosocial intervention to reduce postoperative pain in adolescents undergoing spinal fusion

“…Building from this work, Rabbitts et al 15 proposed a biopsychosocial conceptual model of the transition from acute to chronic postsurgical pain (CPSP) in adolescents, defined as pain that impacts quality of life persisting at least 3 months after surgery 11 , 16 They identified several modifiable psychosocial risk factors that can be targeted perioperatively to reduce the occurrence of CPSP and improve health outcomes, including adolescent anxiety, sleep disruption, parental distress, and low pain self-efficacy. Psychosocial interventions are urgently needed to improve postsurgical pain outcomes for youth and to prevent the transition from acute to chronic postsurgical pain.…”