Long-term pain and psychosocial outcomes in children following major orthopedic surgery

Abstract

Chronic pain is a significant public health problem. A large portion of those with chronic pain have had their acute postsurgical pain transition into a chronic postsurgical pain state. The mechanisms contributing to pediatric persistent postsurgical pain is not well understood; however, there is empirical support in the adult literature to suggest that psychosocial factors play a significant role in the maintenance and exacerbation of post-surgical pain. Recent research by our group found high pain prevalence rates up to 5-years post-surgery among children undergoing spinal fusion surgery, particularly among those reporting poor pre-surgical mental health. The current study aims to extend this research by exploring psycho-social functioning and pain among children (10-21 years) who underwent major orthopedic surgery and their parents (n=21 dyads; data collection is ongoing). Measures administered 1-3 years post-surgery included pain ratings, the Bath Adolescent Pain Questionnaire (Child; Parental Impact), Fear of Pain Questionnaire, Functional Disability Inventory, and the Adult Responses to Child Symptoms. Preliminary results found that 52% of patients reported pain in the moderate-severe range in the past 6 months. Additionally, increased child pain was associated with greater child-reported functional disability (p<.01), pain-specific anxiety (p<.01), and fear of pain (p<.05), as well as worse overall emotional functioning (p<.05). Parents of children with increased pain reported worse parental strain (e.g., "found my relationship with my child difficult," p<.05). Identifying correlates of poor long-term outcomes in children with postsurgical pain may prevent the development of chronic pain into adulthood. With recent economic costs of adult chronic pain estimated to be between $560-$635 billion per year research on the role of persistent pain in children is of upmost importance in order to positively impact pre-surgical preparation, postsurgical care, and in potentially preventing disabling pain into adulthood for a population at considerable risk. This investigation was supported by the Boston Children's Hospital Career Development Fellowship Award (CS).