Prevalence and Predictors of Chronic Postsurgical Pain in Children: A Systematic Review and Meta-Analysis

Abstract

Emerging research suggests that pain may persist longer-term for many children after major surgery, with significant impact on their health outcomes. This systematic review identified the prevalence of chronic postsurgical pain (CPSP) in children after surgery, and determined presurgical biomedical and psychosocial risk factors associated with CPSP prevalence or severity. Prospective studies assessing CPSP 3–12 months after surgery in children 6–18 years of age published in English in MEDLINE, EMBASE, PsycINFO, and Cochrane Database of Systematic Reviews since 1996 were eligible for inclusion. Of 16,084 abstracts yielded by the search, 123 full manuscripts were assessed for eligibility, and 12 studies were included in the review. Overall quality of included studies assessed using the Quality in Prognostic Studies tool was low. Based on 4 studies with a total of 628 participants across all surgery types, median prevalence of CPSP across studies was 20% (25th percentile=14.5%, 75th percentile=38%) at 12 months after surgery. Presurgical pain intensity, child anxiety, child pain coping efficacy, and parental pain catastrophizing were the only presurgical factors identified as predictive of CPSP. Biological and medical factors assessed were not associated with CPSP in any study. Well-designed studies examining prevalence and predictors of CPSP are critically needed in children.

Persistent pain following common outpatient surgeries in children: A multicenter study in Italy

“…The overall prevalence of PPSP in our study is lower than previous prospective pediatric studies. Fortier found postsurgical pain persisting for more than 3 months in 13.3% of patients and a meta‐analysis by Rabbitts showed 11%‐22% at 12 months . Type of surgery is a known risk factor for the development of PPSP in adults and patients in these 2 studies underwent major surgical procedures compared to the more minor nature of our surgeries.…”

“…Evaluation was performed and scores recorded by trained recovery room nurses during the first 1 hour and for the 1‐ to 3‐hour period postoperatively. Scores for the time intervals were averaged and categorized into mild pain, moderate pain, and severe pain for analysis. Intravenous acetaminophen and/or ketorolac, adjusted to age and weight, was administered for a pain score >3 in the PACU.…”

“…Over 2 million children have surgical procedures performed as outpatients but the trajectories of pain after minor surgical procedures, including the development of persistent postsurgical pain (PPSP), are not well understood. PPSP in the adult and pediatric literature is defined variably as substantial pain (scores of 4‐10 using a 0‐10 numeric scale), pain that develops or increases after surgery, is of 3‐6 months duration, affects activities of daily living and has no other apparent cause . There is a paucity of prospective data in children regarding prevalence, risk factors, and overall impact on activities of daily living and most of the published data showing a prevalence of 13%‐20% concern major surgeries performed on an inpatient basis .…”

“…Identified risk factors in adults are female gender, age, genetic, and psychological predisposition, pre‐ and postoperative severity of pain, and surgical nerve injury . Known risk factors in children include preoperative pain and parental catastrophizing . While it is generally believed that PPSP is less common in children than adults, there is little prospective data to support this assumption.…”

Perioperative factors associated with persistent opioid use after extensive abdominal surgery in children and adolescents: A retrospective cohort study

“…As such, we could not investigate the association (or lack thereof) between persistent opioid use and the degree of persistent pain. Furthermore, our study did not include data on catastrophizing or anxiety scores, both of which have been shown to influence pain . Higher scores of catastrophizing have been associated with greater pain‐related increases in IL‐6, which has been shown to mediate hyperalgesia .…”