Prevalence and predictors of chronic postsurgical pain in children: a systematic review and meta-analysis
Open accessAbstract
Emerging research suggests that pain may persist longer-term for many children after major surgery, with significant effects on their health outcomes. This systematic review identified the prevalence of chronic postsurgical pain (CPSP) in children after surgery, and determined presurgical biomedical and psychosocial risk factors associated with CPSP prevalence or severity. Prospective studies assessing CPSP 3 to 12 months after surgery in children 6 to 18 years of age published in English in MedLine, EMBASE, PsycINFO, and Cochrane Database of Systematic Reviews since 1996 were eligible for inclusion. Of 16,084 abstracts yielded by the search, 123 full articles were assessed for eligibility, and 12 studies were included in the review. Overall quality of included studies assessed using the Quality in Prognostic Studies tool was low. On the basis of 4 studies with a total of 628 participants across all surgery types, median prevalence of CPSP across studies was 20% (25th percentile = 14.5%, 75th percentile = 38%) at 12 months after surgery. Presurgical pain intensity, child anxiety, child pain coping efficacy, and parental pain catastrophizing were the only presurgical factors identified as predictive of CPSP. Biological and medical factors assessed were not associated with CPSP in any study. Well designed studies examining prevalence and predictors of CPSP are critically needed in children.Perspective In this systematic review, the median prevalence of CPSP in children was 20% across studies. Presurgical pain intensity, and child and parent psychosocial factors predicted CPSP. Additional resources and interventions are needed for youth who report persistent pain after surgery.
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Presurgical psychosocial distress (including child anxiety, child depression, child pain coping efficacy, and child and parental pain catastrophizing) increases the likelihood of chronic postsurgical pain in children and adolescents.
“Research shows that presurgical psychosocial distress (e.g., child anxiety, child depression, child pain coping efficacy, and child and parental pain catastrophizing) increases the likelihood of CPSP. 13,14,17,18”
From Virtual psychoeducation for improvement of pain catastrophizing in pediatric presurgical patients and caregivers: a proof-of-concept study (2023) · cites this paper as [18]
The Results (Risk factors for chronic postsurgical pain) report associations for greater presurgical child anxiety, poorer pain coping efficacy, and parental pain catastrophizing. They report no association for child pain catastrophizing, and say mood was not associated with the rate of pain decline. The claim therefore overstates which listed factors increase the likelihood of CPSP. (LLM, conf=0.90)
Experimental — accuracy not yet measuredHigher parental pain catastrophizing reliably predicts chronic postsurgical pain in youth.
“Higher parental PC predicts higher chronic postsurgical pain in youth.”
From Virtual psychoeducation for improvement of pain catastrophizing in pediatric presurgical patients and caregivers: a proof-of-concept study (2023) · cites this paper as [18]
The Results (Risk factors for chronic postsurgical pain; page not provided) report an association between presurgery parental pain catastrophizing and chronic postsurgical pain in one study. The Discussion says the evidence is too limited to draw consistent conclusions about risk factors, so it does not support the claim that parental catastrophizing reliably predicts pain. (LLM, conf=0.88)
Experimental — accuracy not yet measuredRecent evidence suggests that catastrophizing may be the main psychosocial driver of persistent pain symptoms, statistically mediating the prospective influence of factors such as anxiety on post-operative pain outcomes.
“recent evidence suggests that catastrophizing may be the principal psychosocial driver of persistent pain symptoms, statistically mediating the prospective influence of factors such as anxiety on post-operative pain outcomes 302.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [302]
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- Authors
- Rabbitts, J. A., Fisher, E., Rosenbloom, B. N., & Palermo, T. M.
- Affiliations
- University of Washington (US)
- Seattle Children's Research Institute (US)
- York University (CA)
- Corresponding author
- Rabbitts, Jennifer A.
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2017-06
- Volume
- 18
- Issue
- 6
- Pages
- 605-614
- ISSN
- 1526-5900 (ISSN-L)
- PMC
- PMC5457338
- OpenAlex
- W2597710207
- Cited by
- 317
- References
- 29
- Citations by year
- 2026: 24 · 2025: 41 · 2024: 42 · 2023: 38 · 2022: 39 · 2021: 48 · 2020: 30 · 2019: 22 · 2018: 24 · 2017: 9
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD078239, K24HD060068)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- chronic postoperative pain, pediatric surgery, children, prevalence, risk factors, childhood anxiety, pain coping, psychosocial factors
- MeSH terms
- Adolescent, Child, Humans, Postoperative Pain, Prognosis, Prevalence, Chronic Pain
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