Brittany N Rosenbloom, Simona Denise Frederiksen, Vienna Wang, Christine S Park, Grace Gordon, Gurpreet Brar, Nivez Rasic, Jennifer N Stinson, Kathryn A Birnie, Jennifer A Rabbitts
{"title":"Prognostic factors of chronic postsurgical pain in children and adolescents: a systematic review and meta-analysis.","authors":"Brittany N Rosenbloom, Simona Denise Frederiksen, Vienna Wang, Christine S Park, Grace Gordon, Gurpreet Brar, Nivez Rasic, Jennifer N Stinson, Kathryn A Birnie, Jennifer A Rabbitts","doi":"10.1136/rapm-2024-105696","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Approximately 28% of children and adolescents undergoing major surgery develop chronic postsurgical pain (CPSP; pain persisting>3 months). A previous review attempted to investigate biopsychosocial prognostic factors for pediatric CPSP; however, due to lack of data, no meta-analytic techniques were employed. Since that review, numerous studies have investigated risk/protective factors that fall within an Interpersonal Fear Avoidance Model for CPSP, thus warranting a reinvestigation of prognostic factors.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aimed to examine prognostic factors, measurement tools applied, and their effect on the development of CPSP.</p><p><strong>Evidence review: </strong>Prospective, observational studies examining prognostic factors of pediatric CPSP using validated self-report measures were included. 4884 unique publications were screened and 15 met inclusion criteria.</p><p><strong>Findings: </strong>The pooled effect size for the association between presurgical child pain intensity and the presence of child CPSP was significant, OR=0.540 (95% CI=0.184 to 0.894). Child anxiety, child pain-related anxiety, and parent pain catastrophizing were not significant prognostic factors for child CPSP. Using Grading of Recommendations, Assessment, Development, and Evaluation, the certainty in prognostic estimates was moderate. Risk of bias using Quality in Prognostic Study tool ranged from low to moderate.</p><p><strong>Conclusions: </strong>Presurgical pain was the only presurgical risk factor at the meta-analytic level that significantly predicted pediatric CPSP, highlighting the importance of prioritizing pain management throughout the perioperative experience, starting before surgery. Depressive symptoms and sleep disturbance were the two potential risk/protective factors that were unable to be assessed due to insufficient data or use of an unvalidated measure indicating a critical need for future research.</p><p><strong>Prospero registration number: </strong>CRD42022306340.</p>","PeriodicalId":54503,"journal":{"name":"Regional Anesthesia and Pain Medicine","volume":"50 2","pages":"144-152"},"PeriodicalIF":5.1000,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11804872/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Regional Anesthesia and Pain Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/rapm-2024-105696","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Approximately 28% of children and adolescents undergoing major surgery develop chronic postsurgical pain (CPSP; pain persisting>3 months). A previous review attempted to investigate biopsychosocial prognostic factors for pediatric CPSP; however, due to lack of data, no meta-analytic techniques were employed. Since that review, numerous studies have investigated risk/protective factors that fall within an Interpersonal Fear Avoidance Model for CPSP, thus warranting a reinvestigation of prognostic factors.
Objective: This systematic review and meta-analysis aimed to examine prognostic factors, measurement tools applied, and their effect on the development of CPSP.
Evidence review: Prospective, observational studies examining prognostic factors of pediatric CPSP using validated self-report measures were included. 4884 unique publications were screened and 15 met inclusion criteria.
Findings: The pooled effect size for the association between presurgical child pain intensity and the presence of child CPSP was significant, OR=0.540 (95% CI=0.184 to 0.894). Child anxiety, child pain-related anxiety, and parent pain catastrophizing were not significant prognostic factors for child CPSP. Using Grading of Recommendations, Assessment, Development, and Evaluation, the certainty in prognostic estimates was moderate. Risk of bias using Quality in Prognostic Study tool ranged from low to moderate.
Conclusions: Presurgical pain was the only presurgical risk factor at the meta-analytic level that significantly predicted pediatric CPSP, highlighting the importance of prioritizing pain management throughout the perioperative experience, starting before surgery. Depressive symptoms and sleep disturbance were the two potential risk/protective factors that were unable to be assessed due to insufficient data or use of an unvalidated measure indicating a critical need for future research.
期刊介绍：
Regional Anesthesia & Pain Medicine, the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA), is a monthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications.
Published for over thirty years, this respected journal also serves as the official publication of the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society for Regional Anesthesia (AFSRA), and the Academy of Regional Anaesthesia of India (AORA).
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