Understanding the Transition from Acute to Chronic Post-Surgical Pain in Youth

Approximately 20% of youth develop chronic post-surgical pain (CPSP) that is associated with pain-related distress and co-morbid mental health outcomes, such as anxiety and depression. This dissertation examines youth and parent risk/protective factors associated with the development and maintenance of pediatric CPSP, including functional limitations. The three studies which comprise this dissertation (Rosenbloom et al., 2019; Rosenbloom et al., 2020; Rosenbloom et al., 2021) use data collected from a large sample of youth aged 8 to 17 years undergoing major orthopedic or general surgery and their parents (n = 264). Youth completed questionnaires at four time points over the course of 12 months (pre-surgery, in-hospital, 6- and 12-months after surgery). In-hospital physical activity was monitored using actigraphy. Youth and parents completed pain and psychological questionnaires. Study 1 results show that 12 months after surgery, over a third of youth report moderate-to-severe post-surgical pain. Trajectory analyses of youth before and through to 12 months after surgery show that youth can be categorized into two main pain intensity and pain unpleasantness groups: high pain and low pain. Further this study revealed that pre-surgical general functional disability is the best predictor of post-surgical functioning, over and above psychosocial and surgery-related factors. Study 2 examined differential risk factors for pain-specific and general functional limitations 12 months after major pediatric surgery. Hierarchical regression analysis showed that youth 12-month pain-specific functional limitations were predicted presurgical youth (pain-related anxiety and worry factor) and parent factors (anxiety sensitivity, state-trait anxiety, pain anxiety). Youth 12-month general functional limitations were predicted by youth general functional limitations and parent anxiety sensitivity. Study 3 examined the validity of the Tampa Scale of Kinesiophobia (TSK) for use in youth after surgery. Results showed that the original 17-item TSK is not a valid measure for youth undergoing surgery, but a modified 13-item TSK has promising psychometric properties for this population. Taken together, these three studies advance our understanding of youth and parent risk/protective factors associated with the development and maintenance of pediatric chronic post-surgical pain and functional limitations