(166) - Psychological factors and interventions: implications for chronic post-surgical pain

Abstract

Neither psychological factors that contribute to the development of chronic post-surgical pain (CPSP) nor interventions for CPSP have been widely investigated in pediatric oncology. This study retrospectively investigates 29 pediatric patients who underwent either limb sparing or amputation definitive surgery secondary to extremity osteosarcoma and the associated non-pharmacological interventions applied in the treatment of neuropathic pain. Psychological factors that can contribute to the development of CPSP were identified and analyzed via Wilcoxon rank-sum test and median two-sample test. Univariate and multivariate Cox regression was utilized to analyze gender, psychological factors, and psychological interventions as factors affecting the duration of CPSP. Patients with psychological diagnoses (M = 107 days, SD = 74.31) experienced significantly longer durations (P = .01) of CPSP compared to patients without psychological diagnoses (M = 47.9 days, SD = 41.56). Similarly, patients who demonstrated resistance to psychological interventions (M = 151.3 days, SD = 74.31) versus those who were accepting of psychology interventions (M = 55.0 days, SD = 47.35) experienced significantly longer durations of CPSP (P = .01). Treatment with psychotropic medications and lack of psychology intervention before surgery demonstrated associations with prolonged CPSP; however, these differences did not reach statistical significance. Furthermore, patients who received preparation/education experienced significantly longer duration of CPSP compared to those who did not receive this intervention (P = .02). Patients without psychological diagnoses and those who were more receptive to psychological interventions were 3.17 times (95% confidence limit [1.328, 7.589], P = .01) and 3.97 times (95% confidence limit [1.155, 13.616], P = .03) more likely to experience faster resolution of CPSP, respectively. The results of this study point to the clinical importance of associated mental health diagnoses and resistance to psychology interventions for the duration of CPSP, and highlight the importance of prospective investigations aimed at evaluating psychological interventions and risk factors for CPSP in pediatric oncology.