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Preventing pediatric chronic postsurgical pain: Time for increased rigor
Christine B Sieberg1,2,3, Keerthana Deepti Karunakaran1,2, Barry Kussman4,5
1Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, Massachusetts, United States.
Insights
Preventing chronic postsurgical pain (CPSP) in children requires addressing pre-, intra-, and postoperative factors. An eight-step plan using analgesia, behavioral interventions, and biomarkers can personalize treatment and improve outcomes.
Area of Science:
- Pain Medicine
- Pediatric Surgery
- Neuroscience
Background:
- Chronic postsurgical pain (CPSP) arises from complex neurobiological and biobehavioral mechanisms.
- Predictors include prior pain, psychological state, surgical load, and acute pain management.
- Effective strategies for pediatric CPSP prevention and treatment remain underdeveloped.
Purpose of the Study:
- To evaluate the perisurgical process for pediatric chronic postsurgical pain.
- To identify key problems and propose solutions for preventing acute-to-chronic pain transition.
- To establish personalized precision medicine for surgical pediatric patients.
Main Methods:
- Proposed an eight-step process for perisurgical pain management.
- Incorporated preemptive/preventative analgesia and behavioral interventions.
- Advocated for using biomarkers (brain, inflammatory, genetic) for timely interventions.
Main Results:
- The proposed process aims to manage pre-, intra-, and postoperative pain states.
- Biomarkers facilitate evaluation of psychological factors and pain.
- Personalized medicine approach targets improved outcomes for pediatric surgical patients.
Conclusions:
- A comprehensive, multi-faceted approach is crucial for pediatric CPSP.
- Personalized strategies incorporating biomarkers can optimize pain management.
- Further research is needed to elucidate pediatric CPSP mechanisms and refine treatments.
Abstract:
Chronic postsurgical pain (CPSP) results from a cascade of events in the peripheral and central nervous systems following surgery. Several clinical predictors, including the prior pain state, premorbid psychological state (e.g., anxiety, catastrophizing), intraoperative surgical load (establishment of peripheral and central sensitization), and acute postoperative pain management, may contribute to the patient's risk of developing CPSP. However, research on the neurobiological and biobehavioral mechanisms contributing to pediatric CPSP and effective preemptive/treatment strategies are still lacking. Here we evaluate the perisurgical process by identifying key problems and propose potential solutions for the pre-, intra-, and postoperative pain states to both prevent and manage the transition of acute to chronic pain. We propose an eight-step process involving preemptive and preventative analgesia, behavioral interventions, and the use of biomarkers (brain-based, inflammatory, or genetic) to facilitate timely evaluation and treatment of premorbid psychological factors, ongoing surgical pain, and postoperative pain to provide an overall improved outcome. By achieving this, we can begin to establish personalized precision medicine for children and adolescents presenting to surgery and subsequent treatment selection.
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