Introduction: Chronic post-surgical pain (CPSP) develops in approximately 20% of youth undergoing major surgery and can have negative consequences on overall quality of life. The risk of developing CPSP is also associated with the presence of other psychological factors (e.g., child anxiety). To address these risk factors, this review is updating the findings from Davidson et al. 2016 to evaluate the efficacy of psychological interventions for pediatric post-surgical pain with new research in the field. 

Methods: A comprehensive search from 2016 - May 5th, 2022 was performed in Medline, Embase, CENTRAL, PsycINFO, and CINAHL databases. Studies were included if they were English peer-reviewed randomized controlled trials evaluating psychological interventions (e.g., distraction, education/preparation, and other cognitive-behavioural strategies) for pediatric (6-18 years old) post-surgical pain. 

 

Results: A total of 3820 abstracts were screened by two reviewers, resulting in the inclusion of 15 full-text articles. Thirteen of 20 original articles from the Davidson et al. review were included, and therefore a total of 28 studies were analysed in the review. Studies included youth with a mean age between 6-15 years and various surgical procedures (e.g., tonsillectomy, circumcision, spinal fusion). Participants received psychological interventions (distraction n=8; imagery/hypnosis n=8; education/preparation n=9; mixed n=3). Interventions were provided before surgery (n=14), in the acute stages after surgery (n=7), before and after surgery (n=4), or intra-operatively (n=3). Primary pain outcome was pain intensity (e.g., NRS 0-10 scale). With the exception of two studies, there was a high risk of bias. Overall, psychological interventions where effective in reducing self-reported pain intensity within 24 hours after surgery (SMD = -0.38, 95% CI (-0.568, -0.184), p < 0.001). More specifically, distraction was effective (SMD = -0.47, 95% CI (-0.764, -0.185), p = .001), but relaxation/ imagery (SMD = -0.41, 95% CI (-0.860, 0.050), p = .081) and education (SMD = -0.25, 95% CI (-0.560 to 0.060), p = .114) were not as compared to standard of care. There were insufficient studies conducting interventions in the weeks after surgery to evaluate their effectiveness using meta-analyses.  

 

Discussion/Conclusion: Differences in intervention type and pain outcome contributed to various levels of intervention efficacy across studies. Psychological interventions may be effective in reducing post-surgical pain in the hours after surgery; however, further research should focus on potential moderators of this relationship as well as evaluate the effectiveness of mixed psychological interventions (e.g., cognitive behavioural therapy) that span weeks after surgery.