Modeling the transition from acute to chronic postsurgical pain in youth: A narrative review of epidemiologic, perioperative, and psychosocial factors

Abstract

A growing number of studies have identified high rates of pediatric chronic postsurgical pain (CPSP) after major surgery. Pediatric CPSP is associated with pain-related distress and comorbid mental health outcomes, such as anxiety and depression. From a biopsychosocial perspective, youth factors, such as genetics, epigenetics, sex, presurgical pain, sleep, anxiety, and pain catastrophizing, as well as parent factors, such as cognitive appraisals of their child’s pain expression and pain catastrophizing, converge and lead to chronic pain disability. A comprehensive and testable psychosocial model of the transition from acute to chronic pediatric postsurgical pain has not been developed. This narrative review begins by evaluating the epidemiology and trajectories of pediatric CPSP and moves on to examine the more influential psychosocial models that have been proposed to understand the development of pediatric CPSP. Much of the literature to date has been conducted on adolescents undergoing spinal fusion. To conceptualize the transition from acute to chronic pain in youth, a combined diathesis-stress and interpersonal fear avoidance model is presented. Novel areas of future research include the potential influence that siblings and peers have on a youth’s development of CPSP as well as the influence of gender.

Chronic Postsurgical Pain in Children and Adolescents: A Call for Action

“…3,17,81,83,85 Despite the heterogeneity in measurements and number of trajectories identified, the finding of distinct pain recovery pathways has been replicated in many pediatric and adult studies. 18,80,100,101 Prospective studies examining acute and chronic postoperative pain trajectories have shown that the majority of children undergo normal recovery with decreasing surgical pain over time. However, there is a subset of patients classified into cohorts with high or severe pain that persists or increases over time.…”

Longitudinal Resilience and Risk Factors in Pediatric Postoperative Pain (LORRIS): Protocol for a Prospective Longitudinal Swiss University Children’s Hospitals-Based Study

“…In sum, previous studies have identified several risk factors for the development of CPSP, among them symptoms of anxiety, preoperative pain intensity and poorer sleep quality as well as parental catastrophising, even though the results were equivocal in part. 5 6 40 The extent to which emotion-related factors can serve as resilience factors has had minimal investigation in the transition from acute to CPSP. 5 Further, the promotion of resilience mechanisms as a prevention strategy has had limited focus in the context of paediatric chronic pain.…”

“… 5 6 40 The extent to which emotion-related factors can serve as resilience factors has had minimal investigation in the transition from acute to CPSP. 5 Further, the promotion of resilience mechanisms as a prevention strategy has had limited focus in the context of paediatric chronic pain. 7 41 …”

Mechanisms inherent in acute-to-chronic pain after surgery – risk, diagnostic, predictive, and prognostic factors

“…Additionally to these recently published studies, the bio-molecular mechanisms of the transition from acute to CPSP are described in three comprehensive reviews 6,95,96▪▪ . This review focuses on adults; for comprehensive reviews on children and adolescents, see refs 96▪▪–99▪ .…”