Psychosocial Predictors of Acute and Chronic Pain in Adolescents Undergoing Major Musculoskeletal Surgery

Rabbitts, Jennifer A.; Palermo, Tonya M.; Zhou, Chuan; Meyyappan, Alagumeena; Chen, Lucas

doi:10.1016/j.jpain.2020.02.004

Cited by 35 publications

(72 citation statements)

References 59 publications

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“…Three studies found that higher baseline anxiety levels before surgery and in the hospital after surgery predicted risk for development and maintenance of CPSP, 26,28,38 and one more recent study demonstrated that higher depressive symptoms in the week before surgery predicted CPSP in youth undergoing major musculoskeletal surgical procedures. 16 However, other studies did not identify relationships between these constructs and CPSP. 10,11 Studies of pain-specific psychological factors include presurgery or immediate postsurgery pain anxiety, pain catastrophizing, pain-related fear, and pain vigilance, as well as protective (resiliency) factors such as pain coping efficacy and pain acceptance; these studies have examined relationships between these factors and acute and chronic postsurgical pain.…”

Section: Psychosocial Factors Emotional and Cognitive Factorsmentioning

confidence: 97%

“…[22][23][24][25] Yet, across pediatric perioperative studies, no associations have been found between pediatric CPSP and child age, 13,26,27 sex, 13,26,28 or socioeconomic factors (eg, family income 13,26 and parents' education). 16 However, small sample sizes with wide age ranges, as well as limited diversity within samples (eg, inclusion of predominantly white, high-income families) limit our understanding of sociodemographic predictors of CPSP. The inclusion of larger and more diverse samples may expose potential relationships between sociodemographic factors and CPSP.…”

Section: Premorbid Factors Demographic Factorsmentioning

confidence: 99%

“…9,12,26,27,45,46 However, studies that better captured the preoperative pain experience through prospectively recorded daily pain scores over multiple days preoperatively found no relationship with development of CPSP. 13,16 Several studies have also examined preoperative pain distribution and centralized pain symptoms (fibromyalgia symptoms), dimensions of pain that have garnered a lot of attention in adult surgical populations, [47][48][49][50] as risk factors for pediatric CPSP. Children's fibromyalgia symptoms (ie, greater pain locations and symptom severity before surgery) predicted more severe acute and chronic postsurgical pain when examined as part of a "high symptom cluster".…”

Section: Medical Factorsmentioning

confidence: 99%

“…51,52 However, when considered as an independent factor, number of preoperative pain locations was not associated with subsequent acute or chronic postoperative pain. 16 The discrepancies between these results emphasize the need for greater rigor and consistency in the measurement of preoperative pain and suggest that a comprehensive assessment of pain characteristics, including not only pain intensity but also pain distribution and location, pain quality, and pain sensitivity, should be further explored. Several studies have examined the association between medical comorbidities, chronic conditions unrelated to the planned surgery, prior chemotherapy use, and prior surgery on the incidence of CPSP, 9,53 finding weak associations.…”

Section: Medical Factorsmentioning

confidence: 99%

“…9,10,51 Looking beyond hospital discharge, studies examining recovery during the initial weeks at home identified significant relationships between subacute pain with subsequent chronic pain. 4,16,28 In general, studies have relied on self-report measures and data from the electronic medical record to assess acute recovery. Future studies should apply more granular monitoring (such as daily pain diaries) and employ objective measures (eg, actigraphy monitoring of activity, electronic medication monitoring of opioid use) to better capture acute recovery.…”

Section: Factors Related To Acute Postoperative Recoverymentioning

confidence: 99%

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<p>A Conceptual Model of Biopsychosocial Mechanisms of Transition from Acute to Chronic Postsurgical Pain in Children and Adolescents</p>

Rabbitts¹,

Palermo²,

Lang³

2020

JPR

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Acute and chronic pain are highly prevalent and impactful consequences of surgery across the lifespan, yet a comprehensive conceptual model encompassing biopsychosocial factors underlying acute to chronic pain transition is lacking, particularly in youth. Building on prior chronic postsurgical pain models, we propose a new conceptual model of biopsychosocial mechanisms of transition from acute to chronic postsurgical pain. This review aims to summarize existing research examining key factors underlying acute to chronic postsurgical pain transition in order to guide prevention and intervention efforts aimed at addressing this health issue in children. As pain transitions from acute nociceptive pain to chronic pain, changes in the peripheral and central nervous system contribute to the chronification of pain after surgery. These changes include alterations in sensory pain processing and psychosocial processes (psychological, behavioral, and social components), which promote the development of chronic pain. Patient-related premorbid factors (eg, demographic factors, genetic profile, and medical factors such as premorbid pain) may further modulate these changes. Factors related to acute injury and recovery (eg, surgical and treatment factors), as well as biological response to surgery (eg, epigenetic, inflammatory, and endocrine factors), may also influence this process. Overall, longitudinal studies examining temporal pathways of biopsychosocial processes including both risk and resiliency factors will be essential to identify the mechanisms involved in the transition from acute to chronic pain. Research is also needed to unravel connections between the acute pain experience, opioid exposure, and sensory pain processing during acute to chronic pain transition. Furthermore, future studies should include larger and more diverse samples to more fully explore risk factors in a broader range of pediatric surgeries. The use of conceptual models to guide intervention approaches targeting mechanisms of transition from acute to chronic pain will significantly advance this field and improve outcomes for children and adolescents undergoing surgery.

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Section: Psychosocial Factors Emotional and Cognitive Factorsmentioning

confidence: 97%

Section: Premorbid Factors Demographic Factorsmentioning

confidence: 99%

Section: Medical Factorsmentioning

confidence: 99%

Section: Medical Factorsmentioning

confidence: 99%

Section: Factors Related To Acute Postoperative Recoverymentioning

confidence: 99%

See 3 more Smart Citations

<p>A Conceptual Model of Biopsychosocial Mechanisms of Transition from Acute to Chronic Postsurgical Pain in Children and Adolescents</p>

Rabbitts¹,

Palermo²,

Lang³

2020

JPR

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Preoperative vs Postoperative Opioid Prescriptions and Prolonged Opioid Refills Among US Youths

Sutherland,

Rabbitts,

Tasian

et al. 2024

JAMA Netw Open

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ImportanceHigh-risk practices, including dispensing an opioid prescription before surgery when not recommended, remain poorly characterized among US youths and may contribute to new persistent opioid use.ObjectiveTo characterize changes in preoperative, postoperative, and refill opioid prescriptions up to 180 days after surgery.Design, Setting, and ParticipantsThis retrospective cohort study was performed using national claims data to determine opioid prescribing practices among a cohort of opioid-naive youths aged 11 to 20 years undergoing 22 inpatient and outpatient surgical procedures between 2015 and 2020. Statistical analysis was performed from June 2023 to April 2024.Main Outcomes and MeasuresThe primary outcome was the percentage of initial opioid prescriptions filled up to 14 days prior to vs 7 days after a procedure. Secondary outcomes included the likelihood of a refill up to 180 days after surgery, including refills at 91 to 180 days, as a proxy for new persistent opioid use, and the opioid quantity dispensed in the initial and refill prescriptions in morphine milligram equivalents (MME). Exposures included patient and prescriber characteristics. Multivariable logistic regression models were used to estimate the association between prescription timing and prolonged refills.ResultsAmong 100 026 opioid-naive youths (median [IQR] age, 16.0 [14.0-18.0] years) undergoing a surgical procedure, 46 951 (46.9%) filled an initial prescription, of which 7587 (16.2%) were dispensed 1 to 14 days before surgery. The mean quantity dispensed was 227 (95% CI, 225-229) MME; 6467 youths (13.8%) filled a second prescription (mean MME, 239 [95% CI, 231-246]) up to 30 days after surgery, and 1216 (3.0%) refilled a prescription 91 to 180 days after surgery. Preoperative prescriptions, increasing age, and procedures not typically associated with severe pain were most strongly associated with new persistent opioid use.Conclusions and RelevanceIn this retrospective study of youths undergoing surgical procedures, of which, many are typically not painful enough to require opioid use, opioid dispensing declined, but approximately 1 in 6 prescriptions were filled before surgery, and 1 in 33 adolescents filled prescriptions 91 to 180 days after surgery, consistent with new persistent opioid use. These findings should be addressed by policymakers and communicated by professional societies to clinicians who prescribe opioids.

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Chronic Postsurgical Pain in Children

Raghavan

Anghelescu

Frett

2023

Pediatric Surgical Oncology

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Psychosocial Predictors of Acute and Chronic Pain in Adolescents Undergoing Major Musculoskeletal Surgery

Cited by 35 publications

References 59 publications

<p>A Conceptual Model of Biopsychosocial Mechanisms of Transition from Acute to Chronic Postsurgical Pain in Children and Adolescents</p>

<p>A Conceptual Model of Biopsychosocial Mechanisms of Transition from Acute to Chronic Postsurgical Pain in Children and Adolescents</p>

Preoperative vs Postoperative Opioid Prescriptions and Prolonged Opioid Refills Among US Youths

Chronic Postsurgical Pain in Children

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