Psychosocial mechanisms underlying the transition from acute to chronic postsurgical pain in youth following spinal fusion: a 6-month longitudinal study

Theoretical and empirical work underscores the role of postsurgical acute pain severity and psychosocial factors in the development of chronic postsurgical pain (CPSP). However, evidence on how psychosocial changes in response to acute pain influence CPSP development in adolescents is limited. In this 6-month longitudinal study, adolescents undergoing spinal fusion were assessed presurgery, monitored for 30 days postsurgery, and re-evaluated at 8 weeks and 6 months. We examined changes in adolescent psychosocial factors (depression, anxiety, and pain catastrophizing) and parental distress from presurgery to 8 weeks postsurgery and tested their mediating effects between postsurgical acute pain intensity and interference, and CPSP development at 6 months. Among 160 adolescents included (10-18 years [M = 14.6, SD = 2.1]; 77% female; 17% Hispanic), 34% developed CPSP (pain intensity ≥3 and quality of life impairment) at 6 months. Adolescents who developed CPSP had higher pain intensity, psychological distress, and parental distress presurgery and 8 weeks postsurgery. Longitudinal causal mediation analyses controlling for sex and presurgery pain and psychosocial factors revealed that changes in adolescent anxiety and pain catastrophizing from presurgery to 8 weeks postsurgery mediated the link between postsurgical acute pain intensity and CPSP, explaining 13.8% and 11.0% of the effect, respectively. In addition, changes in adolescent pain catastrophizing mediated the association between acute pain interference and CPSP, explaining 19.6% of the effect. Significant mediation effects were not observed for changes in adolescent depression or parental distress. Anxiety symptoms and pain catastrophizing are actionable targets both before and after surgery to reduce CPSP development in adolescence.