Background & Aims
Surgical pain responses in pediatric patients is complex, influenced by various biopsychosocial factors, with age being a significant modulator of both biological and psychosocial processes[1]. As individuals’ age, the nervous system undergoes significant developmental changes, including ongoing brain and nervous system maturation[2-4]. This could leads to variations in pain perception, which in the past resulted in undertreatment of pediatric pain due to the historical misconception that complete myelination of nerve pathways was necessary for pain perception[5]. To improve pediatric postsurgical pain management, we need to better understand the relation between age and pain in children. We hypothesize variations in pain perception across different ages during childhood. This study aims to investigate the association between age and postoperative pain and to assess at which ages high pain intensities are most prevalent, and to analyze whether there are differences between sex.
Methods
Data were obtained from the PAIN OUT INFANT registry, including patients aged 4-18 years undergoing appendectomy, tonsillectomy, spinal surgery, orthopedic surgery or hernia repair. Primary aim was the association between worst pain on the first postoperative day and children’s age. Secondary aim was the association of age and perioperative opioid consumption. For missing data, multiple imputation using the mice library was performed to limit bias. All analyses were conducted within each imputed dataset and results were pooled using Rubin’s rules. Linear regression was performed to assess the association between age and pain. An interaction term was added between age and sex to investigate potential differences in pain between sexes. Models were adjusted for a priori selected confounders. Locally estimated scatterplot smoothing (LOESS) lines were constructed to asses the nonlinear relationship between age and worst pain. To compare opioid administration Mann-Whitney U test was used
Results
Of the 2004 included patients, mean age was 10.6±3.8 years and 51% were females. LOESS lines indicate an age-related increase in worst pain scores, peaking around twelve years of age, particularly in females (Figure 1). This was confirmed in our linear regression model showing that females exhibited higher levels of pain compared to males, with pain intensity increasing with age (interaction coefficient; 0,08 95% CI: 0,02-0,15 p=0.017). Other covariates significantly influencing pain scores were surgery type (lower pain scores in hernia surgery (?-0.97 95%CI -1.51 to -0.43) and higher in appendectomy (? 0.71 95%CI 0.30 to 1.12) compared to orthopedic surgery), and regional anesthesia use (?-0.58 95%CI -0.95 to -0.21). Patients under 12 years received lower perioperative opioid doses compared to older patients across all procedures (0.8±1.2 mg/kg vs 1.1±1.6 mg/kg), female patients received high doses of opioids compared to males (1.01±1.46 mg/kg vs 0.82±1.26 mg/kg, p<0.001).
Conclusions
This study examines age and sex related associations of postoperative pain in pediatric patients, elucidating that females experience high pain levels at higher ages compared to male patients,
notably after the age of 12.
Furthermore, there is a progressive increase in opioid consumption associated with age as well as among female patients. Our findings align with a recent meta-analysis [6] focused on experimental pain, which demonstrated significantly higher pain intensity in girls compared to boys, particularly after the age of 12. This underscores the imperative for tailored pain management strategies during critical developmental stages such as puberty. Further exploration into the mechanisms underlying age and sex disparities in postoperative pain is essential for the development of personalized protocols in pediatric surgical care.
References
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Presenting Author
Ruth Zaslansky
Poster Authors
Rachele Simonte
Doctor
Department of Medicine and Surgery, University of Perugia, Perugia, 06123, Italy
Lead Author
Ruth Zaslanky
Jena University Hospital, Friedrich Schiller University, Jena, Germany
Lead Author
Francesca Oppitz
Wilhelmina’s Childrens Hospital, Utrecht, the Netherlands
Lead Author
Alinde Hindriks
Wilhelmina’s Childrens Hospital, Utrecht, the Netherlands
Lead Author
Wolfgang Buhre
University Medical Centre Utrecht, Utrecht, the Netherlands.
Lead Author
Edoardo De Robertis
University of Perugia, Perugia, 06123, Italy
Lead Author
Lisette Vernooij
University Medical Centre Utrecht, Utrecht, the Netherlands
Lead Author
Winfried Meissner
Jena University Hospital, Friedrich Schiller University, Jena, Germany
Lead Author
Ulrike Stamer
Inselspital, Bern University Hospital, Bern, Switzerland
Lead Author
Mienke Rijsdijk
University Medical Centre Utrecht, Utrecht, the Netherlands
Lead Author
Topics
- Gender/Sex Differences