Pediatric Chronic Postsurgical Pain And Functional Disability: A Prospective Study Of Risk Factors Up To One Year After Major Surgery

Abstract

Brittany N Rosenbloom,1 M Gabrielle Pagé,2 Lisa Isaac,3 Fiona Campbell,3 Jennifer N Stinson,4 James G Wright,5 Joel Katz1,6 1Department of Psychology, York University, Toronto, ON, Canada; 2Centre de recherche du Centre hospitalier de l’Université de Montréal and Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada; 3Department of Anesthesia and Pain Medicine, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; 4Department of Anesthesia and Pain Medicine, Hospital for Sick Children, and Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada; 5Department of Surgery, University of Toronto and the Hospital for Sick Children, Toronto, ON, Canada; 6Department of Psychology, The Hospital for Sick Children, Toronto, ON, CanadaCorrespondence: Brittany N Rosenbloom; Joel KatzDepartment of Psychology, York University, 4700 Keele St., Toronto, ON M3J 1P3, CanadaEmail [email protected]; [email protected]: Chronic postsurgical pain (CPSP) is a surgical complication associated with increased functional disability, psychological distress, and economic costs. The aims of this paper were to prospectively: (1) examine the incidence of CPSP 6 and 12 months after pediatric major surgery; (2) identify pain intensity and pain unpleasantness trajectories before, and up to 12 months after, surgery; (3) identify pre-operative factors that predict pain trajectory group membership; and (4) identify predictors of 12-month functional disability.Methods: This study followed 265 children aged 8–17 years at four time points (pre-surgical [T0], in-hospital [T1], 6 [T2] and 12 [T3] months after surgery). Children and parents completed pain and psychological questionnaires. In-hospital physical activity was monitored using actigraphy.Results and discussion: The incidence of moderate-to-severe CPSP at 6 and 12 months was 35% (95% CI 29.1% to 41.9%) and 38% (95% CI 32.4% to 45.1%), respectively. Three percent (95% CI 1.17% to 6.23%) and 4% (95% CI 1.45% to 6.55%) of children reported using opioids to manage pain at 6 and 12 months, respectively. Growth mixture modeling revealed a two-class trajectory model with a quadratic slope best fit the data for both pain intensity (Bayesian information criterion [BIC] = 3977.03) and pain unpleasantness (BIC = 3644.45) over the 12 months. Preoperative functional disability and cumulative in-hospital opioid consumption predicted pain intensity trajectories. Preoperative functional disability predicted pain unpleasantness trajectories. Preoperative functional disability (OR: 1.05, 95% CI: 1.01 to 1.09) and pain unpleasantness trajectories (OR: 2.59, 95% CI: 1.05 to 6.37) predicted 12-month moderate-to-severe functional disability.Conclusion: Pre-surgical functional disability is the only factor that predicts both 12-month functional disability and the course of pain intensity and pain unpleasantness ratings over the 12-month period.Keywords: pain, pediatrics, surgery, trajectory analysis, functional disability, anxiety, depression, parents

Keywords

• pain
• pediatrics
• surgery
• trajectory analysis
• functional disability
• anxiety
• depression
• parents