Special issue: Developmental perspectives on the transition of acute to chronic pain after surgery.

Abstract

It is with great enthusiasm that we present the Canadian Journal of Pain’s Special Issue titled Developmental Perspectives on the Transition of Acute to Chronic Pain after Surgery. Over the past 25 years there has been an exponential growth in research on the factors involved in the transition from acute to chronic pain in infants, children, and adolescents. This Special Issue features novel advances in research and theory underlying the transition from acute to chronic pain using surgery as a model. These advances span basic, clinical, and translational perspectives that highlight a biopsychosocial framework of the development and treatment of pediatric chronic postsurgical pain (CPSP). CPSP develops in 11% to 54% of children and adolescents after major surgery and significantly impacts individual functioning, including school attendance and participation in social and physical activities. The articles in this Special Issue, authored by leading international experts, make it clear that the development of pediatric CPSP is multifactorial and influenced by biological, psychological, and social factors that necessitate a multipronged approach to treatment. Using an eight-step process, Sieberg and colleagues set the stage for future research in pediatric CPSP. They promote the use of ongoing and continuous evaluation and treatment of premitigating factors including premorbid status, surgery, and immediate postsurgery treatments, as well as objective assessment of the transition to chronicity and treatment rehabilitative processes. Essential to the effective assessment and treatment of pediatric CPSP in humans is understanding the biological mechanisms underlying the transition to pain chronicity. Walker’s state-of-the-art review describes the parallels between clinical observation and translational laboratory studies that investigate the acute and long-term effects of surgical injury on nociceptive pathways. Importantly, Walker draws attention to the potential sex-dependent effects of various forms of peripheral and central neuroplasticity, including hyperalgesic or nociceptive priming, that may contribute to an increased risk of CPSP in adults scheduled for surgery who underwent a prior medical procedure or surgery in infancy or childhood. Dourson and colleagues review the current preclinical and clinical evidence for genetic and epigenetic mechanisms relevant to infant, childhood, and adolescent CPSP. They, too, focus on the complex interactions between neurons and immune cells in contributing to the phenomenon of nociceptive priming and to establishing a cellular “memory” of early life injury. Their forward-looking view anticipates the possibility of epigenetically programmed drugs to prevent pediatric CPSP. Individual psychological processes are a key part of pediatric CPSP with psychological factors often preceding the onset of and contributing to the maintenance of CPSP. Higher levels of anxiety, depression, and parent pain catastrophizing, as well as lower levels of youth pain coping efficacy, put children and adolescents at risk of developing CPSP. Memory for pain has been posited to be one of the factors contributing to CPSP. An emerging body of research has examined the role of negatively biased pain memories (i.e., recalling more pain compared to the initial reports) in pediatric CPSP. Remembering more pain after a major surgery predicted higher pain levels 5 months postsurgery. Fear of anxiety-related physical sensations (i.e., anxiety sensitivity) and catastrophic thinking about pain predicted development of negatively biased pain memories that, in turn, are associated with worse postsurgical pain outcomes. Yet, existing research on pain memories has been focused on the accuracy, or lack thereof, of pain recall and has been limited to single-item measures. In contrast, Waisman and colleagues develop a comprehensive model of CPSP involving the autobiographical memory system and propose that an overgeneral memory bias is a risk factor for CPSP. Investigating overgeneral memory in youth undergoing major surgery may allow for a more nuanced examination of pain memories and their contributions to the onset and maintenance of pediatric CPSP. Consistent with the biopsychosocial model of CPSP, and unique to pediatrics, is the role that parents play in their youth’s perioperative pain experience and functional outcomes. Both Newton-John and Rosenbloom and Katz spotlight the potential pathways through which parents and the family system contribute to the youth’s pain coping and functional outcomes. This is a novel area of research within the context of the CANADIAN JOURNAL OF PAIN 2022, VOL. 6, NO. 2, 46–48 https://doi.org/10.1080/24740527.2022.2090323