Chronic pain after pediatric surgery: A qualitative study with children, parents, and healthcare providers

Abstract

Chronic postsurgical pain occurs in around 20% of children after undergoing major surgeries. Child and parent psychosocial risk factors (e.g. anxiety, pain catastrophizing) predict persistence of pain and poor health-related quality of life. Psychosocial interventions aimed at improving longterm pain and recovery need to be developed. The aims of this study were to 1) understand the child's and family's experiences of pain over the course of their surgical experience (before surgery, perioperative period, postsurgery period) and 2) gather stakeholder input from children who underwent surgery, their parents, and perioperative providers regarding potential barriers and facilitators of intervention delivery in the perioperative period. Semi-structured interviews were conducted individually with 15 children age 10-18 years (M=15.4, 60% female) who underwent recent major surgery, their parents, and 17 perioperative healthcare providers. Interviews were coded, according to semantic thematic analysis. The perioperative period was difficult emotionally for children and presented unique stressors for parents. They experienced high levels of worry regarding surgery success and anticipated pain, and struggled to cope during the early perioperative period. Families reported feeling unprepared for the intensity and duration of pain and the length of recovery experienced. Children encountered unexpected challenges with physical recovery and return to school and activities. Both children and parents perceived a need for learning coping skills to help manage pain and anxiety. Providers emphasized that families need more detailed information about what to expect over the entire course of surgery and recovery. Pro-viders expressed feeling ill-equipped to adequately help children and families. Time and distance were recognized as potential barriers of deliveringa psychosocial intervention, with internet delivery identified as a potential facilitator. Research to develop and evaluate interventions to address pain and anxiety in children undergoing major surgery is critically needed.