Persistent postsurgical pain in children and young people: prediction, prevention, and management

Williams, Glyn D.; Howard, Richard; Liossi, Christina

doi:10.1097/pr9.0000000000000616

Cited by 161 publications

(89 citation statements)

References 49 publications

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“…Acute postsurgical pain has been shown to predict chronic pain and opioid use in children and adolescents [6,7]. Moreover, the persistent nature of postoperative pain may delay rehabilitation [4,8].…”

Section: Introductionmentioning

confidence: 99%

Predicting Acute Postoperative Pain Trajectories and Long-Term Outcomes of Adolescents after Spinal Fusion Surgery

Ocay

Ingelmo

et al. 2020

Pain Research and Management

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Objectives. Acute pain trajectories are associated with long-term outcomes such as persistent pain and functional disability in adults. However, there are limited data on acute postoperative pain trajectories in the pediatric population. The aims of this study were to investigate acute postoperative pain trajectories, their predictors, and their impact on long- term outcomes in adolescents with idiopathic scoliosis. Methods. We evaluated the preoperative pain intensity, use of analgesics, psychosocial measures and physical functioning of adolescents scheduled to undergo spinal fusion, and their average 6-hour self-reported pain intensity scores for their entire hospital stay. Six months after surgery, baseline variables were reassessed. We used growth mixture modeling to conduct acute postoperative pain trajectory analysis and to identify predictors of pain trajectories. Generalized linear models were conducted to determine whether acute pain trajectories predict long-term outcomes. Results. One hundred and six patients were included in the best-fitted acute pain trajectory model that included four classes that differed in initial pain intensity and rates of change over time. Preoperative pain catastrophizer status and use of analgesics significantly predicted pain trajectory membership. Furthermore, at the 6-month follow-up, patients experiencing moderate-to-severe pain in the acute postoperative period were more likely to report higher levels of pain severity, use pain medication, and miss a greater number of school/work days due to back pain in the last three months. Discussion. Preoperative assessment and analyzing the progression of pain in the acute postoperative period can help identify those at risk of negative long-term outcomes after surgery.

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Section: Introductionmentioning

confidence: 99%

Predicting Acute Postoperative Pain Trajectories and Long-Term Outcomes of Adolescents after Spinal Fusion Surgery

Ocay

Ingelmo

et al. 2020

Pain Research and Management

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“…In response to a postal questionnaire survey to determine the prevalence of chronic pain in children who had undergone cardiac surgery with sternotomy, Lauridsen found the risk although low is not negligible and may have an associated neuropathic component. Hence, optimum perioperative management of pain should be a priority to decrease the occurrence of chronic pain …”

Section: Introductionmentioning

confidence: 99%

“…Hence, optimum perioperative management of pain should be a priority to decrease the occurrence of chronic pain. 15 One way to overcome this problem is the use of local anesthetic techniques. These techniques can block afferent impulses from corresponding nerves and thereby either reduce the need for opioids or eliminate them completely.…”

mentioning

confidence: 99%

Regional anesthesia for sternotomy and bypass—Beyond the epidural

Raj

2019

Pediatric Anesthesia

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Summary Systemic opioids have been the main stay for the management of perioperative pain in children undergoing cardiac surgery with sternotomy. The location, distribution, and duration of pain in these children have not been studied as extensively as in adults. Currently, there is no consensus to the dose of opioids required to provide optimum analgesia and attenuate the stress response while minimizing their unwanted side effects. At present there is a tendency to use lower dose aiming for early extubation and minimize opioid‐related side effects, but this may not obtund the stress response in all children. The development of chronic pain although rare when compared to adults is still a risk that needs further investigation. Regional anesthetic techniques, by blocking the afferent impulses, have been shown to be advantageous in reducing the stress response to surgery as well as pain and opioid requirements in children up to 24 hours after cardiac surgery. Central neuraxial blockades have not gained wide spread acceptance in these procedures due to the worry of hematoma, although rare, leading to catastrophic neurological outcomes. This review focuses on blocks outside the vertebral column, ie, peripheral nerve blocks, performed either in the front or the back of the chest wall to target the thoracic intercostal nerves. Techniques of ultrasound‐guided bilateral single shot paravertebral block and erector spinae block posteriorly and transversus thoracic plane block anteriorly are discussed. In addition, parasternal block and wound infiltration by surgeon as well as continuous local anesthetic infusion via catheters placed at end of procedures are summarized. Current evidence available for use of these techniques in children undergoing cardiac surgery are reviewed. These are based on small studies and case series and further studies are required to evaluate the risks and benefits of local anesthetic blocks in children undergoing cardiac surgery.

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“…If clinicians do ask patients about pain-related affective or evaluative dimensions, it is currently more art than science as to how they then integrate and respond to this information alongside other physiological and behavioral pain indicators and management protocols. It has been suggested that clinician acute pain treatment decisions are typically based on the presumed mechanism of the pain, previous pain medication use, and clinician experience [3], and there has been little, if any, attention devoted to how best to integrate functional measures, behavioral observations, and children's self-report with such factors. One study found that clinician estimations of a child's procedural pain intensity were influenced by the child's diagnosis, the child's pain behaviors and the clinician's own distress in the anticipatory phase, with higher clinician distress predictive of greater subsequent pain intensity ratings [64].…”

Section: Multidimensional Pain Assessment and Therapeutic Decision-mamentioning

confidence: 99%

“…Acute pain may be taken to include all painful experiences lasting for less than 3 months duration [1]. A thorough acute pain assessment should be conducted within a broader social and developmental perspective, considering information from various sources, which may include self-reported information, behavioral observations, physiological measures, parent-or clinician-reported information, and the patient's medical history [2], complemented by an understanding of pain mechanisms and pathophysiology [3]. Each of these assessment modalities may provide valuable information about the pain experience.…”

Section: Introductionmentioning

confidence: 99%

Why Unidimensional Pain Measurement Prevails in the Pediatric Acute Pain Context and What Multidimensional Self-Report Methods Can Offer

et al. 2019

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Although pain is widely recognized to be a multidimensional experience and defined as such, unidimensional pain measurement focusing on pain intensity prevails in the pediatric acute pain context. Unidimensional assessments fail to provide a comprehensive picture of a child’s pain experience and commonly do little to shape clinical interventions. The current review paper overviews the theoretical and empirical literature supporting the multidimensional nature of pediatric acute pain. Literature reporting concordance data for children’s self-reported sensory, affective and evaluative pain scores in the acute pain context has been reviewed and supports the distinct nature of these dimensions. Multidimensional acute pain measurement holds particular promise for identifying predictive markers of chronicity and may provide the basis for tailoring clinical management. The current paper has described key reasons contributing to the widespread use of unidimensional, rather than multidimensional, acute pediatric pain assessment protocols. Implications for clinical practice, education and future research are considered.

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Persistent postsurgical pain in children and young people: prediction, prevention, and management

Abstract: Ensuring optimum preoperative and postoperative pain management should always be a priority in children.

Cited by 161 publications

References 49 publications

Predicting Acute Postoperative Pain Trajectories and Long-Term Outcomes of Adolescents after Spinal Fusion Surgery

Predicting Acute Postoperative Pain Trajectories and Long-Term Outcomes of Adolescents after Spinal Fusion Surgery

Regional anesthesia for sternotomy and bypass—Beyond the epidural

Why Unidimensional Pain Measurement Prevails in the Pediatric Acute Pain Context and What Multidimensional Self-Report Methods Can Offer

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