Relative contribution of real/sham spinal manipulation performance, changes in cortisol levels, and patient expectations and fear behaviors in modulating short-term pain relief in people with neck pain: A secondary analysis of a randomized clinical trial

Abstract

Prevalence of chronic postsurgical pain (CPSP) and prognostic factors in older children and adolescents have been identified. However, prevalence and prognostic factors in younger children, which may differ from older children, have been minimally studied. Additionally, a significant knowledge gap exists, with few prospective studies investigating long-term outcomes of CPSP in pediatric populations. To address this, our study investigates CPSP prevalence, prognostic factors, and pain trajectories in 4 to 7-year-olds, aiming to enhance understanding within the 24-month period after surgery. Registered under NCT04735211, the study includes 113 young participants (mean age=5.3 years, 35.4% girls) and their parents recruited from a university hospital in Spain. CPSP prevalence was examined at 3, 6, 12, and 24 months post-surgery. Multiple logistic regression models assessed presurgical predictors (child sex, child age, child's pain intensity, physical health, psychological health, parent pain catastrophizing, fear of pain). Group-based trajectory modeling (GBTM) was used to analyze postsurgical pain trajectories. Results indicate a 35% CPSP prevalence at 3 months, decreasing to 12% at 24 months. Older age (aOR=1.83, 95% CI 1.11-3.03) and higher parent pain catastrophizing (aOR=1.20, 95% CI 1.10-1.31) were associated with CPSP at 3 months. GBTM identified three postsurgical pain trajectories: Low Pain (27.4%), Quick Recovery (53.1%), and Slow Recovery (19.5%). Findings provide novel data in this vulnerable younger age group to help understand prevalence of CPSP, physical and psychological prognostic factors and pain trajectories, which may lead to establishing preventative initiatives. PERSPECTIVE: This study provides valuable insights into the high prevalence of CPSP, with rates of 35% at 3 months decreasing to 12% at 24 months. It identifies both modifiable (e.g., parent pain catastrophizing, pain intensity, physical health) and non-modifiable (e.g., age) risk factors in a minimally studied population.