Ceniza-Bordallo Guillermo, Fraile Andrés Gómez, López-de-Uralde-Villanueva Ibai, Rabbitts Jennifer A, Li Rui, Palermo Tonya M, Martín-Casas Patricia
Faculty of Nursing, Physiotherapy and Podiatry, University Complutense of Madrid, Madrid, Spain.
Surgery and Urology Pediatric Unit, University hospital 12 octubre of Madrid, Madrid, Spain.
J Pain. 2025 Jun 23;34:105476. doi: 10.1016/j.jpain.2025.105476.
Prevalence of chronic postsurgical pain (CPSP) and prognostic factors in older children and adolescents have been identified. However, prevalence and prognostic factors in younger children, which may differ from older children, have been minimally studied. Additionally, a significant knowledge gap exists, with few prospective studies investigating long-term outcomes of CPSP in pediatric populations. To address this, our study investigates CPSP prevalence, prognostic factors, and pain trajectories in 4 to 7-year-olds, aiming to enhance understanding within the 24-month period after surgery. Registered under NCT04735211, the study includes 113 young participants (mean age=5.3 years, 35.4% girls) and their parents recruited from a university hospital in Spain. CPSP prevalence was examined at 3, 6, 12, and 24 months post-surgery. Multiple logistic regression models assessed presurgical predictors (child sex, child age, child's pain intensity, physical health, psychological health, parent pain catastrophizing, fear of pain). Group-based trajectory modeling (GBTM) was used to analyze postsurgical pain trajectories. Results indicate a 35% CPSP prevalence at 3 months, decreasing to 12% at 24 months. Older age (aOR=1.83, 95% CI 1.11-3.03) and higher parent pain catastrophizing (aOR=1.20, 95% CI 1.10-1.31) were associated with CPSP at 3 months. GBTM identified three postsurgical pain trajectories: Low Pain (27.4%), Quick Recovery (53.1%), and Slow Recovery (19.5%). Findings provide novel data in this vulnerable younger age group to help understand prevalence of CPSP, physical and psychological prognostic factors and pain trajectories, which may lead to establishing preventative initiatives. PERSPECTIVE: This study provides valuable insights into the high prevalence of CPSP, with rates of 35% at 3 months decreasing to 12% at 24 months. It identifies both modifiable (e.g., parent pain catastrophizing, pain intensity, physical health) and non-modifiable (e.g., age) risk factors in a minimally studied population.
慢性术后疼痛（CPSP）在大龄儿童和青少年中的患病率及预后因素已得到确认。然而，年幼儿童中的患病率及预后因素可能与大龄儿童不同，对此研究极少。此外，存在重大的知识空白，很少有前瞻性研究调查儿科人群中CPSP的长期结局。为解决这一问题，我们的研究调查了4至7岁儿童的CPSP患病率、预后因素及疼痛轨迹，旨在增进对术后24个月内情况的了解。该研究在NCT04735211注册，纳入了从西班牙一家大学医院招募的113名儿童参与者（平均年龄 = 5.3岁，35.4%为女孩）及其父母。在术后3、6、12和24个月检查CPSP患病率。多元逻辑回归模型评估术前预测因素（儿童性别、儿童年龄、儿童疼痛强度、身体健康、心理健康、父母疼痛灾难化、对疼痛的恐惧）。基于组的轨迹建模（GBTM）用于分析术后疼痛轨迹。结果表明，术后3个月CPSP患病率为35%，24个月时降至12%。年龄较大（调整后比值比[aOR]=1.83，95%置信区间[CI] 1.11 - 3.03）和父母疼痛灾难化程度较高（aOR = 1.20，95% CI 1.10 - 1.31）与术后3个月的CPSP相关。GBTM确定了三种术后疼痛轨迹：低疼痛（27.4%）、快速恢复（53.1%）和缓慢恢复（19.5%）。研究结果为这一脆弱的年幼儿童群体提供了新的数据，有助于了解CPSP的患病率、身体和心理预后因素以及疼痛轨迹，这可能有助于制定预防措施。观点：本研究为CPSP的高患病率提供了有价值的见解，术后3个月患病率为35%，24个月时降至12%。它在一个研究较少的人群中确定了可改变的（如父母疼痛灾难化、疼痛强度、身体健康）和不可改变的（如年龄）风险因素。
