Sex differences in adolescent chronic pain outcomes after spinal fusion: role of coping strategies.

ABSTRACT Sex differences in postsurgical pain are poorly understood in adolescence, a critical period for chronic pain development. The aims of this analysis were to examine sex differences in chronic pain outcomes 6 months after spinal fusion and test whether pain coping strategies, specifically differences in distraction-based coping and emotion-focused avoidance, explained these differences. Adolescents (N = 145; 78% females; ages 10-18; 67% White; 17% Hispanic) undergoing surgery for idiopathic/juvenile scoliosis, spondylolisthesis, or kyphosis were included. Outcomes were chronic postsurgical pain (CPSP) at 6 months, usual and movement-evoked pain intensity, and pain interference. Pain coping at 2 months post-surgery was assessed with the Pain Coping Questionnaire. Mediation analyses with g-formula and bootstrapping estimated indirect effects of pain coping. At 6-month post-surgery, females had higher CPSP incidence vs males (38% vs 13%, P = 0.006), higher usual (3.0 vs 1.8, d = 0.66, P < 0.001) and movement pain (2.0 vs 1.1, d = 0.43, P = 0.028), and higher pain interference (24.5 vs 13.2, d = 0.51, P = 0.009). At 2 months, females endorsed more internalizing/catastrophizing (d = 0.51, P = 0.025) and emotion-focused avoidance (d = 0.46, P = 0.047), whereas males reported more behavioral distraction (d = 0.75, P < 0.001). Internalizing/catastrophizing and emotion-focused avoidance mediated higher CPSP incidence in females, explaining 37.8% and 44.6% of the associations, respectively. Behavioral distraction mediated higher movement pain and pain interference in females, explaining 46.5% and 34.4% of the associations, respectively. Findings highlight the role of pain coping in shaping sex differences in postsurgical pain during adolescence and the potential for targeted, coping-focused interventions to improve long-term outcomes and reduce sex disparities.