Peer-reviewed article
Chronic postsurgical pain in children: Current evidence and clinical perspectives.
Godhwal P, Gupta A, Sirohi A, Gupta N ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This review examines chronic pain that persists after surgery in children, which affects 10-63% of young patients depending on the type of surgery. The condition is associated with psychological problems, reduced function, and poor long-term health outcomes. Risk factors include the child's psychological state, previous pain experiences, and the type of surgery performed. Various prevention and treatment approaches such as pain management before surgery, cognitive behavioural therapy, and acupuncture have been attempted with inconsistent results. The authors highlight significant gaps in current knowledge and call for better research and specialized pain clinics for children recovering from surgery.
Key points
- Chronic postsurgical pain affects 10-63% of children undergoing surgery, with higher rates after high-risk procedures like spine surgery, hernia repair, and thoracotomy
- The condition is defined as chronic pain developing or worsening after surgery that persists beyond three months without other causes
- Risk factors include psychological factors, pre-existing pain, intensity of postsurgical pain, and type of surgery performed
- Preoperative pain management strategies, cognitive behavioral therapy, and acupuncture show varied success but lack robust evidence
- Early referral to transitional pain clinics and rehabilitation may improve outcomes, but concrete evidence is limited
Limitations
This is a narrative review without systematic methodology, so it cannot provide definitive conclusions about intervention effectiveness. The review identifies a significant knowledge gap in the literature, with highly variable definitions of CPSP and predominantly low-quality studies in the pediatric population, limiting what can be concluded about prevalence and risk factors.
Abstract
The chronification of acute pain following surgery is increasingly recognized, with a reported prevalence of 10%-63%, likely reflecting the increasing number of surgical interventions performed in the pediatric population. This pain is more severe after high-risk surgeries, such as spine surgery, hernia repair, and thoracotomy. Currently, the literature reports highly variable definitions of chronic postsurgical pain (CPSP) owing to a lack of objective diagnostic parameters. The International Association for the Study of Pain defines CPSP as "chronic pain that develops or increases in intensity after surgery or a tissue injury and persists beyond three months, without other causes". This pain can be localized to the surgical field or referred to the affected nerve domain. Similarly, the reported incidence of CPSP in children is largely from low-quality studies and varies between 20% and 50% in the studied population. Its neuropathic features are strongly associated with psychological consequences, functional limitations, and adverse long-term health outcomes. Potential risk factors in the pediatric population include psychosocial behaviors, pre-existing pain, postsurgical pain intensity, and the type of surgery performed. Proposed pathophysiological mechanisms include a pro-inflammatory state after surgery, leading to altered peripheral and central sensitization, genomic factors, epigenetic modifications, and altered brain physiology associated with chronic pain. Understanding the pathophysiology helps target interventions for pre-existing pain, surgery-related pain, anxiety, and opioid-induced hyperalgesia. Preoperative protocolized analgesic strategies, cognitive behavioral therapy, and acupuncture have been tried with varied success rates, although concrete data are lacking. The literature on regional analgesia is still limited in the pediatric population and represents a potential area for further research. Furthermore, rehabilitation interventions addressing postoperative trajectories with early referral to transitional pain clinics may offer promising avenues for improving outcomes. There is a significant knowledge gap, a scarcity of available data on CPSP, and difficulties in addressing pain in the pediatric population, underscoring the need for this review.