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Updated: Aug 6, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Age-related patterns in postoperative pain: insights from the paediatric pain out registry: A prospective cohort
Rachele Simonte1, Ruth Zaslansky, Francesca Oppitz
1From the Department of Medicine and Surgery, University of Perugia, Perugia, Italy (RS, EDR), Department of Anaesthesiology and Intensive Care, University Hospital Jena, Jena, Germany (RZ, WM), Division of Paediatric Anaesthesiology, Department of Anaesthesiology, University Medical Centre Utrecht, Wilhelmina's Childrens Hospital, Utrecht, The Netherlands (FO, AH, WB), Pain Clinic, Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands (AH, WB, LV, MR), Department of Anaesthesiology ad Pain Medicine, Inselspital, Bern University Hospital and Department of BioMedical Research, University of Bern, Switzerland (US).
Insights
Postoperative pain is common in children, with 79% experiencing moderate to severe pain. Pain intensity increases with age, peaking around 12 years, especially in girls, highlighting the need for age and sex-specific pain management.
Area of Science:
- Pediatric Surgery
- Pain Management
- Clinical Research
Background:
- Postoperative pain is a frequent issue in pediatric patients.
- The influence of age and sex on pediatric postoperative pain requires further investigation.
Purpose of the Study:
- To determine how postoperative pain intensity varies across different age groups in children.
- To identify specific ages with the highest prevalence of pain and functional impairment.
- To analyze potential sex-based differences in the relationship between age and postoperative pain.
Main Methods:
- A cohort study involving 2005 pediatric patients (aged 4-18) undergoing common surgeries.
- Data collected prospectively from the international PAIN OUT registry across Germany, the Netherlands, and Austria.
- Analysis of postsurgical pain scores using regression models, adjusted for surgery type, duration, opioid use, and regional anesthesia.
Main Results:
- 79% of children reported moderate to severe postoperative pain.
- Pain intensity demonstrated an age-related increase, peaking around age 12, particularly in girls.
- Appendectomy and lack of regional anesthesia were linked to increased pain intensity.
- Higher opioid doses were administered to older children (12+) for appendectomy and spine surgery.
Conclusions:
- A significant majority of pediatric patients experience moderate to severe postoperative pain.
- Pain severity is associated with age, with a notable peak in girls around puberty.
- Findings underscore the necessity for tailored pediatric pain management strategies that account for age and sex variations.
Background:
Postoperative pain is common in children, yet its relationship to age and sex remains underexplored.
Objectives:
We hypothesise that postoperative pain intensity varies across age groups. The objective is to identify ages at which high pain with functional impairment is most prevalent and assess any sex difference in the association between age and postoperative pain.
Design:
Cohort study.
Setting:
Data were extracted from the paediatric PAIN OUT registry, an international registry. Data were prospectively collected at hospitals in Germany, the Netherlands and Austria.
Patients:
The study includes 2005 patients aged 4 to 18 years who underwent appendectomy, tonsillectomy, hernia repair, orthopaedic, or spinal fusion surgery.
Main Outcome Measures:
Postsurgical pain scores (Faces Pain Scale 0 to 10) were compared between surgical procedures, stratified by sex, and age. The association between the primary outcome, 'worst pain' score on the first day after surgery, and age and sex was analysed using regression models adjusted for confounding factors: surgery type, duration, perioperative opioid consumption, and use of regional anaesthesia.
Results:
Postoperative pain intensity was high with 79% of children experiencing moderate to severe pain, increasing with age, peaking around 12 years, particularly in girls. The regression model confirmed an age-related increase in pain intensity in females (interaction coefficient: 0.08, 95% confidence interval 0.02 to 0.15, P = 0.017). Appendectomy and not receiving regional anaesthesia were associated with higher pain intensity. Higher mean oral morphine equivalent doses were given to patients aged 12 years or older for appendectomy (0.57 ± 0.52 vs. 0.60 ± 0.66 mg kg -1 , P = 0.003) and spine surgery (2.1 ± 1.6 vs. 2.7 ± 2.4 mg kg -1 , P = 0.038), with comparable doses between the sexes.
Conclusions:
In this paediatric cohort, 79% experienced moderate to severe postoperative pain, with higher scores in children aged 12+ and a peak in girls around the onset of puberty. These findings emphasise the need for improved paediatric pain management with consideration for age and sex-related differences.
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