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An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 28, 2010
Prevalence and Predictors of Chronic Postsurgical Pain in Children: A Systematic Review and Meta-Analysis
Jennifer A Rabbitts1, Emma Fisher2, Brittany N Rosenbloom3
1Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.
Insights
Chronic postsurgical pain (CPSP) affects 20% of children after surgery. Presurgical pain intensity and psychosocial factors like anxiety and coping predict its development. More research is needed to understand and manage pediatric CPSP.
Area of Science:
- Pediatric Surgery
- Pain Management
- Psychosocial Health
Background:
- Chronic postsurgical pain (CPSP) is an emerging concern in pediatric populations, potentially impacting long-term health outcomes.
- Risk factors for developing CPSP in children require further investigation to inform prevention and treatment strategies.
Purpose of the Study:
- To systematically review the prevalence of chronic postsurgical pain (CPSP) in children.
- To identify presurgical biomedical and psychosocial risk factors associated with CPSP prevalence or severity in pediatric patients.
Main Methods:
- Systematic review of prospective studies published since 1996 in major databases (MedLine, EMBASE, PsycINFO, Cochrane).
- Inclusion criteria: studies assessing CPSP 3-12 months post-surgery in children aged 6-18 years.
- Quality assessment using the Quality in Prognostic Studies tool indicated low overall quality of included studies.
Main Results:
- Median prevalence of CPSP was 20% at 12 months post-surgery, based on 4 studies with 628 participants.
- Identified presurgical predictors of CPSP included pain intensity, child anxiety, child pain coping efficacy, and parental pain catastrophizing.
- No significant association was found between biological/medical factors and CPSP.
Conclusions:
- Chronic postsurgical pain (CPSP) affects a significant proportion of children, with a median prevalence of 20% at 12 months.
- Presurgical psychosocial factors and pain intensity are key predictors of CPSP in pediatric populations.
- There is a critical need for well-designed studies to further examine the prevalence and predictors of CPSP in children to guide interventions.
Abstract:
Emerging research suggests that pain may persist longer-term for many children after major surgery, with significant effects 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 to 12 months after surgery in children 6 to 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 articles 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. On the basis of 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.
Perspective:
In this systematic review, the median prevalence of CPSP in children was 20% across studies. Presurgical pain intensity, and child and parent psychosocial factors predicted CPSP. Additional resources and interventions are needed for youth who report persistent pain after surgery.
