Psychosocial Factors and Psychological Interventions: Implications for Chronic Post-Surgical Pain in Pediatric Patients
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Psychosocial Factors and Psychological Interventions: Implications for Chronic Post‑Surgical Pain in Pediatric Patients with Osteosarcoma Jennifer M. Allen1 · Kristin Niel2 · Andy Guo3 · Yin Su4 · Hui Zhang5 · Doralina L. Anghelescu6 Accepted: 13 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract This study retrospectively investigated psychological factors contributing to chronic post-surgical pain (CPSP) in pediatric patients after limb-sparing or amputation surgery for extremity osteosarcoma. Psychological factors were identified and analyzed by the Wilcoxon rank-sum and median two-sample tests. Univariate and multivariate Cox regressions were performed using gender, age, psychological factors, and psychological interventions related to CPSP duration as covariates. Duration of pain treatment was significantly longer in patients resistant to psychological interventions (p = 0.01) than those receptive to interventions. Shorter duration of pain treatment was associated with older age (p = 0.03) and receptiveness to psychological interventions (HR = 4.19, 95% CI [1.22, 14.35]). Older age and receptiveness to psychological interventions as part of pain management care are associated with needing a shorter duration of pain treatment. Our results highlight the importance of prospective investigations evaluating motivation to engage in psychotherapy and psychological interventions and identify risk factors for CPSP in pediatric oncology. Keywords Pediatric oncology · Chronic post-surgical pain · Non-pharmacological pain management · Pediatric pain · Psychosocial risk factors
Background
* Jennifer M. Allen [email protected] 1
Department of Psychology, St. Jude Children’s Research Hospital, 262 Danny Thomas Pl, MS: 101, Memphis, TN 38105, USA
2
Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
3
College of Medicine, University of Illinois, Rockford, IL, USA
4
Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
5
Department of Preventative Medicine – Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
6
Division of Anesthesiology, Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
Chronic post-surgical pain (CPSP) has been well described in adults (Kehlet, Jensen, & Woolf, 2006; Macrae, 2008; Richebe, Julien, & Brulotte, 2015), including types of surgeries most likely to be the eliciting factor, identified risk factors, and recommendations for prevention strategies. Defined as pain persisting for more than 3–6 months (Kehlet et al., 2006), or more than 2 months after surgery (International Association for the Study of Pain), CPSP occurs in 10–50% of adults. In 2–10% of patients, CPSP becomes disabling, with pain scores exceeding 5 out of 10 at 6 months after surgery (Kehlet et al., 2006; Macrae, 2008). Psychosocial risk factors for the development of CPSP in adult
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