Psychological predictors can identify children at risk for higher pain intensity after surgery

Some 5 million children undergo surgery every year in the United States, and it is estimated that up 60 percent have moderate to severe pain while in the hospital. Recent studies suggest that post-surgical pain may persist beyond the healing period for children following general or orthopedic surgical procedures. Published research has established the importance of biopsychosocial factors in predicting pain after surgery in adults.

Researchers with the University of Washington Seattle Department of Anesthesiology and Pain Medicine examined the impact of major surgery on pain and quality of life in children over time. They identified psychosocial and behavioral factors at baseline that predicted acute postsurgical pain intensity and impaired quality of life two weeks after surgery. They hypothesized that pre-surgical assessments of higher anxiety, pain catastrophizing, shorter sleep duration and higher parental catastrophizing about child pain would predict greater pain intensity and quality of life impairment.

Sixty families agreed to participate in the study. Children were assessed the week preceding surgery and follow-up occurred two weeks after the procedures. This is the first study to prospectively identify psychosocial risk factors for acute post-surgical pain in children after major surgery.

Results showed that higher levels of parental catastrophizing and shorter child sleep duration significantly predicted higher levels of post-surgical pain. Also, higher child anxiety just before surgery predicted more quality of life impairments.

The authors noted that inclusion of parent perceptions in the analysis yielded important information on the potential role of child and parent emotions prior to surgery. Further, child anxiety, parental catastrophizing, and sleep factors are modifiable factors that could be targets for preventative intervention strategies.