Approximately 20% of youth undergoing major surgery develop chronic postsurgical pain (CPSP). However, preventive interventions for CPSP have yielded mixed results, partly due to the limited involvement of patients and caregivers in the intervention development process. Single-session interventions (SSI) are well-suited in this context, as they are time- and cost-efficient. This study investigates the perioperative needs of patients and caregivers, and utilizes these insights to co-develop a preventive psychological SSI for post-surgical pain. Two rounds of focus groups were conducted with patients and caregivers to (1) gather information on the perioperative experience of patients and caregivers to develop the content of a preventive SSI, and (2) gather feedback on the draft of the intervention. Participants' experiences were analyzed applying structural content analysis. Based on these results, the content of a digital intervention was developed, which was then presented to participants for evaluation, and feedback was analyzed using participatory observation. Five adolescent patients and four mothers took part in the focus groups. In total, 5 superordinate categories were identified: Consequences of context (i.e., contextual components), looking after yourself (i.e., self-care related components), limitations of healthcare system (i.e., healthcare system-based components), requests for medical staff (i.e., specific expectations directed toward providers) and child as primary focus (i.e., child-focused components). The intervention draft was well accepted by participants, and minor suggestions for improvement were implemented. Our study identifies core topics of importance for patients undergoing major surgery and their caregivers, and informs the development of a preventive psychological intervention.

Although most imaging assessments are made qualitatively, quantitative measurements in orthopedic imaging are becoming more important in detecting subtle findings and assessing degrees of abnormality, which can help direct surgical management. In the knee, patellofemoral maltracking is a common cause of anterior pain, particularly in younger patients. Failure to recognize this pathophysiology may result in accelerated chondral loss and osteoarthritis (OA), and the imaging findings may be subtle. As a result, clinicians and radiologists have developed numerous measurements to detect and quantify patellofemoral alignment. Additional entities, such as femorotibial subluxation or angular abnormalities, may only be detected by using standardized measurements and can help detect ligamentous insufficiency or developmental malalignment, which can lead to instability and OA in the medial and lateral femorotibial compartments. Finally, the proper positioning and hardware selection for knee arthroplasty are critical to preventing early hardware failure and postsurgical pain. This review, which focuses on the knee, is the second in a three-part series discussing the appropriate imaging modalities on which to obtain specific lower extremity measurements as well as proper measurement techniques, grouped by pathology. Furthermore, the normal value or range of values according to current literature is reported, along with the significance of abnormal measurements.

Preoperative anxiety and chronic postsurgical pain: a signal worth acting on, but clinical translation needs greater nuance

Complex regional pain syndrome (CRPS) and chronic postsurgical pain (CPSP) are postoperative outcomes that present with debilitating symptoms for patients. The recovery of patients with these conditions is complicated by the lack of standardized prevention and treatment strategies. Current literature suggests that vitamin C may prevent the development of CRPS. Due to the overlapping proposed mechanisms of CRPS and CPSP, the aim of this review is to summarize the available data on the benefits of vitamin supplementation on CRPS and CPSP. A search of the literature for articles published in the last 10 years was conducted. Systematic reviews, meta-analyses, case reports, and articles that were not published in English were excluded. Ultimately, 10 articles met inclusion criteria. The data suggests that systemic vitamin C plays a significant role in preventing CRPS following various orthopedic surgeries and may possess therapeutic benefit as well. Vitamin B12 improved short-term functional and mental health outcomes as well as decreased neuropathic analgesic consumption. While no clinical studies have been performed on alpha-lipoic acid (ALA), preclinical studies suggest that administration decreases cold allodynia and pain in mice models. Moreover, while no studies have evaluated the effects of vitamin D on CRPS and CPSP, retrospective analysis reveals that CRPS incidence is increased in patients with low vitamin D levels. The literature reviewed reveals that there may be value in considering nutritional supplementation through vitamins in CRPS and CPSP, however, large-scale, randomized controlled clinical trials are warranted to evaluate the potential beneficial effects of these supplements in patients.

Functional MRI (fMRI) provides complementary insights into brain network organization during rest (rs-fMRI) and external stimulation (t-fMRI). While rs-fMRI reveals intrinsic connectivity patterns, t-fMRI reflects stimulus-dependent network responses. However, how these states relate to each other in animal disease models remains incompletely understood. We performed sequential acquisition of rs-fMRI and t-fMRI during low- and high-intensity mechanical paw stimulation in a rat model of post-surgical pain (PSP) and SHAM controls. Functional connectivity and network organization were analyzed using network-based statistics and graph-theoretical metrics. In addition, supervised classification of node-level network parameters was performed using linear discriminant analysis (LDA), and regional contributions to network separation were quantified using Mahalanobis distance metrics. Global connectivity strength and small-world organization were preserved across different imaging conditions in both groups, indicating stable network topology. However, multivariate classification revealed clear modality-dependent network signatures in SHAM animals that were markedly reduced in PSP. Region-wise Mahalanobis analyses showed that stimulus-related network shifts were more heterogeneous in SHAM animals, with higher dispersion and recurrent regional "hotspots", whereas PSP animals exhibited more uniform and spatially diffuse responses. These findings indicate that post-surgical pain primarily affects the flexibility of regional network reconfiguration rather than global topology. Combining rs- and stimulus-based fMRI thus provides complementary insight into disease-related network alterations that are not detectable from resting-state data alone.

Chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA) remains a significant clinical challenge. This study aimed to investigate the association between concurrent lumbar degenerative disease (LDD) and CPSP after TKA for knee osteoarthritis (KOA). A total of 348 KOA patients undergoing first unilateral TKA (June 2023-June 2025) were enrolled and stratified into LDD (n = 167) and non-LDD (n = 181) groups. CPSP incidence, pain severity, and postoperative knee function were compared. Logistic regression models were constructed to identify influencing factors for CPSP after TKA. At 6 months postoperatively, both groups showed significant improvements in knee function, mobility, and pain (all P < 0.05). Compared with the non-LDD group, the LDD group exhibited lower knee society scores, reduced knee range of motion, a shorter 6-minute walk distance, a longer timed up and go test time, higher visual analogue scale (VAS) scores for pain at rest and during activity, a higher rate of non-steroidal anti-inflammatory drug use, and a higher incidence of CPSP (all P < 0.05). Depression/anxiety history, preoperative VAS scores, and LDD were independently associated with CPSP after TKA in patients with KOA (all P < 0.05). Among patients with KOA with concurrent LDD, depression/anxiety history, preoperative VAS scores, and preoperative radicular symptoms were independently associated with CPSP after TKA (all P < 0.05). LDD is independently associated with CPSP after TKA. In patients with KOA with concurrent LDD, preoperative radicular symptoms, depression/anxiety history, and intense preoperative pain further increase CPSP risk.

Cathepsin G (CTSG) is a neutrophil-derived serine protease implicated in inflammatory pain modulation. Genetic variation in CTSG may influence postoperative pain susceptibility. This study evaluated the association between CTSG polymorphisms, CTSG plasma concentration and enzymatic activity, and long-term pain after cardiac surgery. We conducted a prospective cohort study including 255 Caucasian adults undergoing elective cardiac surgery via median sternotomy. CTSG single nucleotide polymorphisms (SNPs) rs2070697, rs2236742, and rs45567233 were genotyped. A random subsample of 107 patients underwent measurement of CTSG plasma concentration and enzymatic activity. Pain intensity (visual analogue scale [VAS]) at rest and with movement was assessed at 24 hours, 1 month, 6 months, and 12 months. Ordinal logistic regression was used to analyze associations between CTSG variants and pain. Mendelian randomization evaluated the causal effect of CTSG activity on pain. Overall, 16/250 patients (6.4%) reported moderate to severe postsurgical pain during movement at 6 months, and 6/178 patients (3.3%) at 12 months. At 1 month, pain was associated with higher BMI (P = .016); at 12 months, it was more frequent in women (P < .001) and in patients using antidepressants (P = .022). The rs2070697 AA genotype was associated with reduced pain at 1 month at rest (GA vs AA: OR = 4.329, 95%CI = 1.523-12.310, P = .006), 6 months at rest and in movement (GA vs AA at rest: OR = 4.642, 95%CI = 1.535-14.040, P = .007; GA vs AA in movement: OR = 3.509, 95%CI = 1.169-10.530, P = .025), and 12 months in movement (GA vs AA: OR = 5.754, 95%CI: 1.492-22.200, P = .011). In contrast, the rs2236742 AA genotype was associated with increased pain at all three time points (P < .05). Carriers of rs2236742 AA also reported greater preoperative informational anxiety (GG vs AA: OR = 0.193, 95%CI: 0.049-0.758, P = .018). CTSG activity was lower in rs2070697 A-allele carriers (P = .03). CTSG activity and pain showed no causal association. No significant relationships were found for rs45567233. Variants appear to modulate susceptibility to prolonged post-sternotomy pain. These findings warrant validation in larger multi-ethnic cohorts to clarify mechanisms and potential implications for personalized perioperative pain management.

Effects of putative chronic pain models on locomotor activity in female and male mice.

Symptom Networks in Postsurgical Cancer Pain Across Recovery Stages.

Risk of chronic post-surgical pain using the GENDOLCAT preoperative risk prediction model: Implementation in a university hospital.

To enhance hospital efficiency, ambulatory surgery (AS) has emerged and flourished in China. Oral and maxillofacial surgeries, particularly procedures such as wisdom tooth extraction in the field of alveolar surgery, are well-suited for AS. However, in clinical practice, it has been observed that patients undergoing oral and maxillofacial AS have a relatively high incidence of acute postsurgical pain (APSP). Therefore, the primary objective of this study is to develop and validate a predictive model for moderate-to-severe APSP following oral and maxillofacial surgery. Four hundred forty-five patients who received AS (e.g., extraction of impacted tooth, enucleation of jaw cyst, arthroscopic disc repositioning, excision of superficial oral lesion, etc.) at Nanjing Medical University's Affiliated Stomatological Hospital between June 2024 and January 2025 were retrospectively evaluated. The least absolute shrinkage and selection operator (LASSO) regression and univariate analysis were employed to identify predictors in the training set. A multivariate logistic regression analysis was utilized to construct the predictive model. Bootstrap resampling was applied for internal model validation, and the temporal validation cohort included 73 July 2025 AS patients at the same center. In this study, sex, age, smoking history, and intraoperative use of tropisetron were identified as independent risk variables. The area under the curve (AUC) for the prediction model was 0.7443, 0.7308, and 0.725 in training, internal validation and temporal validation sets. The AUC value ranged from 0.73 to 0.75, indicating that the model has moderate discriminative ability. Our findings indicate that age, gender, smoking history, and intraoperative tropisetron use were associated with moderate-to-severe APSP within 24h after ambulatory oral and maxillofacial surgery. A well-performing prediction model was developed and validated to estimate the risk of APSP in these patients.

To investigate whether adding early upper-limb aerobic exercise to usual postoperative rehabilitation reduces the incidence of chronic postsurgical pain (CPSP) at 6 months after total knee arthroplasty (TKA). Eighty patients undergoing primary unilateral TKA were randomized to the intervention or control groups. Both groups received usual postoperative rehabilitation, and the intervention group additionally performed upper-limb ergometer exercise on postoperative days 2-14. The primary outcome, CPSP at 6 months, occurred at very low rates in both the intervention (2.6%) and control (2.4%) groups. The estimated risk difference was 0.1% (95% confidence interval: -12.1% to 12.8%). No significant between-group differences were observed in secondary outcomes. The effect of adding upper-limb aerobic exercise to usual rehabilitation remains inconclusive, given the extremely low event rate and wide confidence intervals. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN000046684), registered 20 January 2022.

To describe the characteristics of paediatric postoperative patients with cognitive dysfunction and assess the prevalence of pain and associated factors. A descriptive observational study. Cross-sectional study in children and adolescents who had undergone surgery in the previous 72 h with cognitive dysfunction impeding verbal communication of pain. The Spanish-language version of the revised Face, Legs, Activity, Cry and Consolability scale was used to assess pain intensity. The 51 included patients underwent 1072 pain assessments. Moderate to severe pain was detected in 12.1% of the evaluations (n = 130). Girls showed more intense pain after analgesia than boys. Higher pain intensity before analgesia was associated with neurodegenerative disease and autism spectrum disorder. In children with cognitive dysfunction, female sex and baseline cognitive conditions seem to be associated with more intense postsurgical pain. Hospital pain management protocols should differentiate between patients with cognitive dysfunction and patients with neurotypical development. - This study addresses the prevalence of postsurgical pain in paediatric patients with cognitive dysfunction and associated factors - 12.1% of postsurgical evaluations showed moderate to severe pain. Female sex and baseline cognitive conditions seem to be associated with more intense postsurgical pain. - This research will have an impact on the care of paediatric patients with cognitive dysfunction in postsurgical hospitalization units. This study was performed according to EQUATOR GUIDELINES and the STROBE statement. No Patient or Public Contribution.

ObjectiveWe aimed to analyze the effects of pain catastrophizing on Chronic postsurgical pain(CPSP) and postpartum depression(PPD) in cesarean section(CS).MethodsWomen who underwent CS at our hospital between January 15th 2023 and August 15th 2023 were included. Pain catastrophizing was assessed before the surgery. The outcomes were the incidence of CPSP and PPD at 3, 6 and 12 months postoperatively. Bivariate logistic regression was used to identify risk factors for CPSP and PPD. Confounding factors were adjusted to determine the association between preoperative pain catastrophizing and CPSP and PPD.ResultsA total of 658 women were followed up after CS. The incidence of CPSP at 3, 6 and 12 months postoperatively were 18.8% (124/658), 9.3% (61/658) and 3.5% (23/658), respectively. The incidence of PPD at 3, 6 and 12 months were 14.0% (92/658), 6.8% (45/658) and 5.9% (39/658), respectively. Univariate analysis revealed significant differences between the CPSP and no-CPSP groups, as well as the PPD and no-PPD groups, in terms of BMI incision length, intraoperative hemorrhage, inadequate analgesia, and pain catastrophizing at 3, 6, and 12 months postoperatively (P<0.05). Spearman correlation analysis showed that pain catastrophizing was correlated with CPSP at 3, 6, 12 months and PPD at 3 months (P<0.05). Binary logistic regression analysis showed that, after controlling for confounding variables, pain catastrophizing was associated with an increased risk of CPSP at 3 months (odds ratio [OR]=2.501, 95% confidence interval [CI]=1.265‒4.926) and PPD at 3 months (OR=2.144, 95% CI=1.116‒4.117), but not CPSP (OR=0.645, 95% CI=0.265–1.568) and PPD at 6 months (OR=0.531, 95% CI=0.249–1.131) or CPSP (OR=0.818, 95% CI=0.959–1.501) and PPD (OR=0.979, 95% CI=0.936–1.024) at 12 months after surgery.ConclusionAlthough the long-term effects of pain catastrophizing require further research, medical professionals still need to conduct brief psychoeducation in the preoperative period, conducting routine PCS screening to identify high-risk patients to reduce the incidence of CPSP and PPD after CS.

Pre-surgical stress is a well-recognised risk factor for persistent post-surgical pain, and while the precise underlying neurobiological mechanisms remain unknown, neuro-immune interactions are believed to play a pivotal role. Here, we investigated the effect of repeated restraint stress (RRS) on post-surgical somatosensory hypersensitivity and affective responding in male rats and examined underlying mechanisms. We showed that RRS induced behavioural despair, reduced body weight gain and elevated faecal corticosterone levels in male Sprague-Dawley rats. Following paw incision surgery, animals pre-exposed to RRS exhibited exacerbated mechanical and heat hypersensitivity, pain-related aversion, and anxiety-like behaviour compared to non-stress counterparts. RNAseq analysis revealed alterations in expression of glial markers and inflammasome pathways in the dorsal horn of the spinal cord in the RRS + paw incision group, compared to paw incision alone, data further confirmed by immunohistochemistry and RT-qPCR analysis. Intrathecal administration of Interleukin-1 receptor antagonist (IL-1Ra) or MCC950 (an NLRP3 inhibitor) attenuated the RRS-induced increase in pain-related aversion and mechanical hypersensitivity post-surgery. Chronic administration of the β-adrenergic receptor antagonist propranolol, but not the glucocorticoid receptor antagonist RU486, attenuated the RRS-induced exacerbation of mechanical hypersensitivity, pain-related aversion and anxiety-like behaviour post-surgery. These findings suggest that RRS exacerbates and prolongs post-surgical somatosensory and affective pain responding via β-adrenergic receptor activation and increased spinal microglial NLRP3-IL-1β signalling. These data provide further insight into the mechanisms by which chronic stress and mood disorders exacerbate and prolong post-surgical pain.

While most adolescents display a steady recovery trajectory following surgery, some develop chronic postsurgical pain (CPSP), which can significantly impact their functioning. Psychosocial factors are known to play a role in the recovery from pain following surgery, but positive psychosocial factors have received little attention in the literature. This study aimed to address this gap by investigating parental and adolescent positive affect and optimism as predictors of postsurgical pain recovery and positive outcomes in adolescents. This study uses data collected as part of a larger longitudinal project that involved administering questionnaires to adolescents and their parents over multiple timepoints. Adolescent participants aged 12 to 18 years old with a diagnosis of adolescent idiopathic scoliosis, and scheduled for spinal fusion surgery, were recruited across 4 Belgian hospitals along with their parents. Structural Equation Modelling was used to investigate how parental and adolescent positive affect and optimism predicted postsurgical outcomes, including mood, quality of life, and functional disability in adolescents. The study comprised 94 adolescent-parent dyads. Parental optimism before surgery predicted increased adolescent mood following surgery. Adolescent positive affect before surgery predicted increased mood and decreased pain intensity following surgery, while adolescent optimism predicted increased quality of life. None of the optimism or positive affect variables were significantly related to adolescent functional disability following surgery. Study findings identify parental and adolescent positive affect and optimism as potential predictors of postsurgical recovery and positive outcomes in adolescents. However, the multifaceted and complex nature of these relationships warrants further investigation.

Persistent post-lumbar pain syndrome (PSPS) type II is a frequent condition in Pain Units, with limited treatment options such as epidural corticosteroids or epidurolysis. Epidural pulsed radiofrequency (PRF) using a catheter has been reported as more effective than transforaminal PRF. This study evaluates the efficacy of epidural PRF with or without corticosteroids in patients with PSPS type II. A randomized, controlled, multicentre trial included 131 patients. Participants were allocated to either a control group receiving epidural corticosteroids alone or an experimental group receiving epidural PRF plus corticosteroids. Outcomes were assessed with the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), DN4 questionnaire, and Patient Global Impression of Improvement (PGI-I) at 1, 2, 4, and 6 months. Of the 131 patients, 72 were assigned to PRF + steroids and 59 to control. The PRF + steroids group showed significantly greater improvement in VAS (p ≤ 0.002 across follow-ups), ODI (p ≤ 0.004), DN4 (p ≤ 0.015), and PGI-I (p ≤ 0.004) compared with control. Number needed to treat for a 2-3 point reduction in VAS ranged between 2.7 and 2.9. No major complications were observed, and adverse effects were minor and transient. Epidural PRF combined with corticosteroids provides superior pain relief, functional improvement, and patient satisfaction compared with corticosteroids alone in PSPS type II. This technique appears safe, with no significant complications, and represents a promising minimally invasive option for managing persistent post-surgical lumbar radiculopathy. This randomized controlled trial provides the first multicentre evidence that epidural pulsed radiofrequency combined with corticosteroids is more effective than corticosteroids alone for persistent spinal pain syndrome type II. The study shows sustained improvements in pain, disability, and patient-reported outcomes with a favourable safety profile, supporting epidural PRF as a valuable therapeutic option for complex post-surgical lumbar pain.

This randomized controlled trial evaluated the effectiveness of group-based online Acceptance and Commitment Therapy (ACT) compared with treatment as usual (TAU) in improving postsurgical outcomes in patients with degenerative lumbar conditions. A total of 91 participants scheduled for lumbar surgery were randomly assigned to either ACT or TAU, with primary analyses conducted in a modified intention-to-treat sample of participants who underwent surgery (n = 54). Outcomes and process variables were assessed at baseline, post-treatment (pre-surgery), and at 3-, 6- and 12-month post-surgery follow-up. Linear mixed model analysis showed that ACT (vs. TAU) produced larger reductions in pain interference (primary outcome) at post-treatment (d = 1.86) and at 3-month (d = 1.82), 6-month (d = 1.49) and 12-month post-surgery follow-up (d = -1.68). ACT yielded greater improvements than TAU in secondary outcomes, including depressive/anxiety symptoms (d = 1.69-1.99), pain catastrophizing (d = 0.84-0.97), kinesiophobia (d = 0.76-0.92) and low back pain-related disability (d = 1.39-1.91); and process variables, including psychological flexibility (d = 1.71-2.44) and pain acceptance (d = 2.33-3.04). Across time, no significant between-group differences in pain severity were observed. No indirect effects of ACT (vs. TAU) on outcomes through process variables were found. Clinically relevant number needed to treat values for pain interference response were obtained at 3-month (NNT = 4), 6-month (NNT = 2) and 12-month (NNT = 4) post-surgery follow-ups. Overall, these findings support the importance of delivering ACT before surgery to improve pain-related outcomes. This randomized controlled trial provides evidence that preoperative group-based Acceptance and Commitment Therapy (ACT) improves pain-related outcomes following lumbar surgery. ACT produced reductions in pain interference, depressive/anxiety symptoms, pain catastrophizing, kinesiophobia, low back pain-related disability, psychological flexibility and pain acceptance, with clinically meaningful numbers needed to treat. These findings extend existing evidence by demonstrating the effectiveness of ACT delivered before surgery and support the integration of perioperative psychological interventions into routine surgical care for patients with degenerative lumbar conditions.

Patients undergoing thoracoscopic pulmonary resection are prone to moderate-to-severe acute postoperative pain, which not only increases the risk of pulmonary complications but may also lead to chronic postsurgical pain. While traditional opioids provide effective analgesia, they are associated with significant adverse effects. Intercostal nerve block (ICNB) can precisely relieve incisional pain but has a limited duration of action. Tegileridine is a novel biased μ-opioid receptor agonist, offering favourable analgesic efficacy with fewer adverse reactions. Currently, there is a lack of research on the combination of tegileridine and ICNB for analgesia following thoracoscopic pulmonary resection, warranting further clinical exploration. This single-centre, randomised, double-blind, non-inferiority trial is designed to compare the postoperative analgesic efficacy of tegileridine-based patient-controlled intravenous analgesia (PCIA) combined with ICNB versus sufentanil-based PCIA combined with ICNB in patients undergoing thoracoscopic pulmonary resection. A total of 118 participants are enrolled and randomly assigned in a 1:1 ratio to either the tegileridine group or the sufentanil group. The primary outcome is the pain Visual Analogue Scale score during movement within 48 hours postoperatively, with non-inferiority determined using a margin of -1 point and 95% CIs. Secondary outcomes include the number of rescue analgesic interventions, PCIA-related parameters (total analgesic consumption, number of effective presses and total number of presses), incidence of opioid-related adverse events (respiratory depression, postoperative nausea and vomiting) and overall patient satisfaction. The trial protocol was approved by the Medical Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology on 14 February 2026 (Approval No. 2026-S010). The findings will be disseminated through publication in a peer-reviewed journal and on relevant institutional websites. NCT07386626.

Pain catastrophizing in breast cancer survivors with refractory postsurgical pain following breast cancer surgery referred for invasive management.