Coping Skills in Children: An Introduction to the Biopsychosocial Model of Pain Control as a Tool to Improve Postoperative Outcomes

Abstract

Pain management is a significant challenge for both families and physicians following major orthopaedic surgery in children. Psychosocial factors such as anxiety, catastrophizing, and self-efficacy have all been documented to affect postoperative pain. Unfortunately, interventions attempting to address these different variables have been limited across pediatric orthopaedics. In this article, we review the psychosocial constructs that impact a child's ability to manage pain while recovering from pediatric orthopaedic surgery. Additionally, we will highlight some promising coping skills and resilience interventions to date as well as what the ‘ideal’ psychosocial intervention might encompass. By familiarizing our colleagues with the evidence behind each of these concepts, we hope to improve surgeon confidence in managing psychosocial issues and catalyze efforts aimed at addressing this important knowledge gap. Key Concepts: • The biopsychosocial model of pain suggests that there is a complex interplay of biological, psychological, social, and cultural factors that influence the intensity of pain that someone experiences in response to a given stimulus. • The psychosocial contributors to postoperative pain may be divided into three categories: 1) the thoughts and feelings of individual patients; 2) the influence of parents and family; and 3) broader societal and cultural factors. • In addition to traditional analgesics, the ideal perioperative pain management pathway would employ psychosocial strategies as a primary treatment option prior to surgery in order to reduce acute postoperative pain, improve patient and family satisfaction, and prevent the conversion of acute-to-chronic pain. • The ultimate analgesic after musculoskeletal surgery likely includes a combination of resiliency, greater self-efficacy, and appropriate parental support. • There is a significant opportunity for pediatric orthopaedists to collaborate across disciplines in order to build improved perioperative care pathways that integrate early use of psychosocial strategies as part of a comprehensive, multimodal approach to pain management.