Acute to Chronic Postoperative Pain in Children: Does it Exist?

Abstract

The transition from acute to chronic pain after surgery is a well-studied clinical syndrome that was first described approximately 10 years ago. Since then, a substantial body of literature has evolved exploring this phenomenon in significant detail [1–7]. Known as chronic postoperative surgical pain (CPSP), this clinical entity is highly prevalent, reportedly affecting anywhere from 5 to 50% of adults recovering from surgery. According to the International Association for the Study of Pain, CPSP is a pain syndrome of at least 2 months’ duration, occurs postoperatively, and does not result from other causes such as chronic infection or pre-existing disease. Several predictive patient factors for developing CPSP in adults have been recognized, including the severity of acute postoperative pain, female gender, young age, obesity, preoperative anxiety, pain catastrophizing and a history of pre-existing pain. Acute postoperative pain has emerged as one of the strongest predictors of CPSP [8]. Furthermore, a number of surgical procedures associated with an increased risk of CPSP have been identified such as inguinal herniorrhaphy, thoracotomy, breast surgery and limb amputation. Unfortunately, treatment of CPSP can be a challenging task for the healthcare provider and a difficult burden for the patient to bear. Not only may the patient suffer from significant negative functional and social impact, but there are substantially increased healthcare and economic costs incurred as well. Despite the breadth of evidence examining CPSP in adults, this is a relatively unstudied topic in the pediatric population. Little is known about CPSP in children: whether it even exists, the number of children affected, possible predisposing risk factors and the long-term impact of the disease. Because over 5 million children undergo surgery in the USA each year, the risk of developing CPSP in children is a very real and significant threat. It is reported that the majority of children suffer from clinically significant acute postoperative pain and that this pain is overwhelmingly undertreated, particularly in the home setting [9–15]. A review of the literature found two retrospective questionnaire studies examining the occurrence of CPSP in children [16,17]. These two studies enrolled adult patients who had surgery as children