Prevalence and Factors Affecting Postsurgical Pain in Pediatric and Adolescent Patients
Abstract
Background: Post-surgical pain (PSP) can persist from the immediate post-operative period up to 6 months following surgery. The purpose of this study was to evaluate the prevalence of PSP and identify factors influencing its intensity in pediatric and adolescent patients.
Methods: This cross-sectional study included 120 patients aged 3-17 years who had undergone surgery in hospitals. The data for this study were collected by reviewing patients’ clinical records and observing patient behavior. The FLACC scale was used to assess pain in children, and the APPT scale was used to assess pain in adolescents. Demographic data extracted from patients’ clinical records, along with pain data from the FLACC and APPT scales, were entered into SPSS 20 software, and data analysis was performed.
Results: The study included 120 patients with a mean (SD) age of 11.21 (4.03) years, of whom 64 (53.3%) were female. Regarding pain severity in the pediatric group, 2 (3.3%) reported no pain, 14 (23.3%) reported mild pain, 30 (50%) reported moderate pain, and 14 (23.3%) reported severe pain. In the adolescent group, 2 (3.3%) reported no pain, 7 (11.7%) reported little pain, 12 (20%) reported medium pain, 15 (25%) reported large pain, and 24 (40%) reported the worst possible pain. There was no statistically significant relationship between pain status, type of surgery, and gender in either the pediatric or adolescent group (P > 0.05).
Conclusion: Given the high reported rates of post-surgical pain in pediatric and adolescent patients, targeted interventions are recommended to mitigate pain severity and improve patient outcomes.
[2] Messerer B, Gutmann A, Weinberg A, Sandner-Kiesling A. Implementation of a standardized pain management in a pediatric surgery unit. Pediatric Surgery International. 2010;26(9):879-89.
[3] Cai Y, Lopata L, Roh A, Huang M, Monteleone MA, Wang S, et al. Factors influencing postoperative pain following discharge in pediatric ambulatory surgery patients. J Clin Anesth. 2017; 39:100-4.
[4] Marseglia GL, Alessio M, Da Dalt L, Giuliano M, Ravelli A, Marchisio P. Acute pain management in children: a survey of Italian pediatricians. Ital J Pediatr. 2019;45(1):156.
[5] Khalighi E, Ghiasi G, Karimi E, Borji M, Salimi E, Tarjoman A, et al. Assessment of mental health elderly with chronic pain based on quranic components. J Relig Health. 2020;59:2807-18.
[6] Schoeffel D, Casser HR, Bach M, Kress HG, Likar R, Locher H, et al. [Risk assessment in pain therapy]. Schmerz. 2008;22(5):594-603.
[7] Salazar JH, Goldstein SD, Yang J, Douaiher J, Al-Omar K, Michailidou M, et al. Regionalization of the surgical care of children: a risk-adjusted comparison of hospital surgical outcomes by geographic areas. Surgery. 2014;156(2):467-74.
[8] Gharavifard M, Sharifian M, Reihani AR. Retrospective study of postoperative mortality at a tertiary children's hospital in Iran: A cross sectional study. J Pediatr Surg. 2022;57(9):234-9.
[9] Hatefi M, Parvizi R, Borji M, Tarjoman A. Effect of Self-Management Program on Pain and Disability Index in Elderly Men with Osteoarthritis. Anesth Pain Med. 2019;9(4):e92672.
[10] Mohammadi HR, Asadoola Y, Erfani A, Amin NG, Karimiyarandi H, Sadeghi S, et al. Effectiveness of Pulse Intravenous Infusion of Methylprednisolone on Pain in Patients with Lumbar Disc Herniation: A Randomized Controlled Trial. Anesthesiology and Pain Medicine. 2024;14(4).
[11] Khalil H, Shajrawi A, Henker R. Predictors of severe postoperative pain after orthopedic surgery in the immediate postoperative period. Int J Orthop Trauma Nurs. 2021; 43:100864.
[12] Rabbitts JA, Fisher E, Rosenbloom BN, Palermo TM. Prevalence and predictors of chronic postsurgical pain in children: a systematic review and meta-analysis. J Pain. 2017;18(6):605-14.
[13] Alm F, Lundeberg S, Ericsson E. Postoperative pain, pain management, and recovery at home after pediatric tonsil surgery. Eur Arch Otorhinolaryngol. 2021;278(2):451-61.
[14] Jones K, Engler L, Fonte E, Farid I, Bigham MT. Opioid Reduction Through Postoperative Pain Management in Pediatric Orthopedic Surgery. Pediatrics. 2021;148(6).
[15] Shay JE, Kattail D, Morad A, Yaster M. The postoperative management of pain from intracranial surgery in pediatric neurosurgical patients. Pediatr Anesth. 2014;24(7):724-33.
[16] Dorkham MC, Chalkiadis GA, von Ungern Sternberg BS, Davidson AJ. Effective postoperative pain management in children after ambulatory surgery, with a focus on tonsillectomy: barriers and possible solutions. Paediatr Anaesth. 2014;24(3):239-48.
[17] Fortier MA, MacLaren JE, Martin SR, Perret-Karimi D, Kain ZN. Pediatric pain after ambulatory surgery: where's the medication? Pediatrics. 2009;124(4):e588-95.
[18] Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287-98.
[19] Tunc Tuna P, Tuna HI, Molu B, Yildirim Keskin A. Factors Affecting Postoperative Pain Beliefs Among Surgical Patients in Türkiye: A Cross-Sectional Study. Pain Manag Nurs. 2024;25(3):e265-e70.
[20] Köse Tamer L, Sucu Dağ G. The assessment of pain and the quality of postoperative pain management in surgical patients. Sage Open. 2020;10(2):2158244020924377.
[21] Balasundaram P, Avulakunta ID. Human Growth and Development. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.; 2025.
[22] Malviya S, Voepel-Lewis T, Burke C, Merkel S, Tait AR. The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment. Paediatr Anaesth. 2006;16(3):258-65.
[23] Pedersen LK, Rahbek O, Nikolajsen L, Møller-Madsen B. The revised FLACC score: Reliability and validation for pain assessment in children with cerebral palsy. Scand J Pain. 2015;9(1):57-61.
[24] Jacob E, Mack AK, Savedra M, Van Cleve L, Wilkie DJ. Adolescent pediatric pain tool for multidimensional measurement of pain in children and adolescents. Pain Manag Nurs. 2014;15(3):694-706.
[25] Gillies ML, Smith LN, Parry-Jones WL. Postoperative pain assessment and management in adolescents. Pain. 1999;79(2-3):207-15.
[26] Madi D, Badr LK. Translation, Cross-Cultural Adaptation, and Validation of the Adolescent Pediatric Pain Tool (APPT) for Multidimensional Measurement of Pain in Children and Adolescents. Pain Manag Nurs. 2019;20(6):549-55.
[27] Mekonnen ZA, Melesse DY, Kassahun HG, Flatie TD, Workie MM, Chekol WB. Prevalence and contributing factors associated with postoperative pain in pediatric patients: A cross-sectional follow-up study. Perioperative Care and Operating Room Management. 2021;23:100159.
[28] Power NM, Howard RF, Wade AM, Franck LS. Pain and behaviour changes in children following surgery. Archives of Disease in Childhood. 2012;97(10):879-84.
[29] Carreon LY, Sanders JO, Diab M, Sucato DJ, Sturm PF, Glassman SD, et al. The minimum clinically important difference in Scoliosis Research Society-22 Appearance, Activity, And Pain domains after surgical correction of adolescent idiopathic scoliosis. Spine. 2010;35(23):2079-83.
[30] Lillehei CW, Masek BJ, Shamberger RC. Prospective study of health-related quality of life and restorative proctocolectomy in children. Diseases of the colon & rectum. 2010;53(10):1388-92.
[31] Batoz H, Semjen F, Bordes-Demolis M, Bénard A, Nouette-Gaulain K. Chronic postsurgical pain in children: prevalence and risk factors. A prospective observational study. BJA: British Journal of Anaesthesia. 2016;117(4):489-96.
| Files | ||
| Issue | Article in Press |
|
| Section | Research Article(s) | |
| Keywords | ||
| Postsurgical pain Pediatric Adolescent | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
