Influence of psychological and somatosensory characteristics on treatment outcomes in adolescent chronic postsurgical and primary pain

Introduction Chronic postsurgical pain (CPSP) affects 20% to 30% of pediatric patients at 12 months after surgery. We hypothesized that differences in biopsychosocial and somatosensory profiles exist between patients with CPSP and those with chronic primary pain (CPP) and that these differences affect treatment outcomes.

Methods This cohort included prospectively collected, retrospectively analyzed data from adolescents treated at the Edwards Family Interdisciplinary Center for Complex Pain between May 2016 and May 2022. During clinic intake, patients completed the Functional Disability Inventory, Revised Child Anxiety and Depression Scale, and Pittsburgh Sleep Quality Index to assess for disability, anxiety, depression, and sleep quality, respectively. Baseline quantitative sensory testing/conditioned pain modulation (QST/CPM) was performed to characterize somatosensory functioning. The primary outcome was a score of 6 ("much better") or 7 ("very much better") on the Patient Global Impression of Change (PGIC) measure at treatment end.

Results Of 99 patients (14.8 ± 2.0 years, 90% female), 46 had CPSP and 53 had CPP. Compared to CPP, patients with CPSP had less baseline functional disability, coexisting depression, and social phobia and better sleep quality. After adjusting for psychosocial differences, patients with CPSP were more likely to score ≥6 on PGIC than patients with CPP (odds ratio = 3.0 [95% confidential interval: 1.3-7.7], P = 0.01). Patients with dynamic mechanical allodynia and/or temporal summation were less likely to score ≥6 on PGIC compared to patients without (odds ratio = 0.33 [95% confidential interval: 0.13-0.82], P = 0.02).

Conclusion Differences in biopsychosocial factors, somatosensory profiles, and treatment outcomes exist between patients with CPSP and CPP. The presence of centrally driven pain hypersensitivity on baseline QST/CPM was associated with worse recovery prognosis.