Grant: Travel Awards - Institute Community Support

Chronic Postsurgical Pain (CPSP) is an adverse effect of surgery defined as pain that persists for at least three months after surgery. CPSP is associated with longer recovery, disruptions in normal childhood development, and increased health care costs. Chronic pain disproportionately affects more females than males. While there is extensive literature on the transition from acute to chronic post-surgical pain in adults, the transition in children is far less studied. The aims of this study were to follow a group of 265 children undergoing major surgery at four time points (pre-surgical, in-hospital, 6- and 12-months after surgery) in order to: (1) examine the incidence of CPSP in children 6- and 12- months after surgery; (2) identify pain intensity and pain unpleasantness trajectories beginning before and through to 12 months after surgery; (3) identify pre-operative factors that predict group trajectory membership; and (4) identify factors that predict disability at 12-months. To accomplish these aims, children and parents completed questionnaires at each time point. The results of this study showed that 35% and 38% of children reported moderate-to-severe CPSP at 6- and 12-months, respectively. Analyses revealed that a two-class trajectory model with a quadratic slope best fitting the data for both pain intensity and pain unpleasantness over the course of 12-months. Significant predictors of pain intensity trajectories included functional disability and sex. Significant predictors of pain unpleasantness trajectories included functional disability. Preoperative functional disability and pain unpleasantness trajectories predicted 12-month moderate-to-severe functional disability. In conclusion, the results from this study raise the possibility that "prehabilitation" interventions administered in advance of surgery, which address functional disability and pain-related psychological factors, may minimize functional disability in the long-term.