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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.

Canadian Journal of Pain = Revue Canadienne De La Douleur
|May 9, 2022
PubMed
Summary

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.

Keywords:
analgesiabiomarkerchronic paincognitive behavioral therapyfNIRSopioidspostoperative painsurgery

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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.