Objectives: Both parental and child factors have been previously associated with persistent or recurrent postoperative pain in children. Yet, little is known about the relative contribution of parent factors or whether child symptom factors might impact the association between parent factors and long-term pain. The aim of this study was to explore the associations between parent factors, child symptomology and the child's long-term pain outcomes after surgery.

Methods: This prospective, longitudinal study included parents and their children who were scheduled to undergo spinal fusion for underlying scoliosis. Parents completed baseline surveys about their pain history, pain relief preferences (i.e., preference to relieve their child's pain vs. avoid analgesic risks) and pain catastrophizing (i.e., beliefs about their child's pain). Children were classified previously into high vs. low symptom profiles at baseline based on their self-reported pain, catastrophizing, fatigue, depression, anxiety. Children were assessed one year after surgery for their long-term pain interference scores and analgesic use. Serial regression modeling was used to explore whether associations between parent factors and the outcomes were changed when accounting for child factors.

Results: 76 parent/child dyads completed all surveys. Parental preferences and catastrophizing were atemporally associated with the child's baseline psychological-somatic symptom profile. Though parent and child factors were both associated with the long-term pain outcomes, when all three factors were accounted for, the associations between parent factors and long-term pain was fully attenuated the child's profile.

Discussion: These findings suggest that the relationship between parent factors and long-term postoperative pain outcomes may be dependent on the child's symptom profile at baseline. Since there may be bidirectional relationships between parent and child factors, interventions to mitigate long-term pain should address child symptoms as well as parental factors.

Keywords: Persistent postoperative pain; adolescents; children; parental pain catastrophizing; symptomology.