Godhwal P, Gupta A, Sirohi A, Gupta N. Chronic postsurgical pain in children: Current evidence and clinical perspectives. World J Clin Pediatr 2026; 15(3): 119840 [DOI: 10.5409/wjcp.119840]
Corresponding Author of This Article
Nishkarsh Gupta, Professor, Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Room No. 139 FF IRCH, New Delhi 110029, Delhi, India. drnishkarsh@rediffmail.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Godhwal P, Gupta A, Sirohi A, Gupta N. Chronic postsurgical pain in children: Current evidence and clinical perspectives. World J Clin Pediatr 2026; 15(3): 119840 [DOI: 10.5409/wjcp.119840]
Poonam Godhwal, Aarzoo Sirohi, Nishkarsh Gupta, Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Anju Gupta, Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Co-first authors: Poonam Godhwal and Anju Gupta.
Author contributions: Godhwal P, Gupta A, and Gupta N contributed to study conception, definition of intellectual content, and literature search; Godhwal P and Gupta A contributed equally to this manuscript as co-first authors; Godhwal P, Gupta A, Sirohi A, and Gupta N contributed to manuscript preparation, editing, review, and final approval.
AI contribution statement: AI tools were used during manuscript preparation. Specifically, Microsoft Copilot and Grammarly were utilized for language editing, grammar correction, and rephrasing of selected sections to improve clarity and readability.
Conflict-of-interest statement: None of the authors report relevant conflicts of interest for this article.
Corresponding author: Nishkarsh Gupta, Professor, Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Room No. 139 FF IRCH, New Delhi 110029, Delhi, India. drnishkarsh@rediffmail.com
Received: February 7, 2026 Revised: March 17, 2026 Accepted: June 12, 2026 Published online: September 9, 2026 Processing time: 173 Days and 12.5 Hours
Abstract
The chronification of acute pain following surgery is increasingly recognized, with a reported prevalence of 10%-63%, likely reflecting the increasing number of surgical interventions performed in the pediatric population. This pain is more severe after high-risk surgeries, such as spine surgery, hernia repair, and thoracotomy. Currently, the literature reports highly variable definitions of chronic postsurgical pain (CPSP) owing to a lack of objective diagnostic parameters. The International Association for the Study of Pain defines CPSP as “chronic pain that develops or increases in intensity after surgery or a tissue injury and persists beyond three months, without other causes”. This pain can be localized to the surgical field or referred to the affected nerve domain. Similarly, the reported incidence of CPSP in children is largely from low-quality studies and varies between 20% and 50% in the studied population. Its neuropathic features are strongly associated with psychological consequences, functional limitations, and adverse long-term health outcomes. Potential risk factors in the pediatric population include psychosocial behaviors, pre-existing pain, postsurgical pain intensity, and the type of surgery performed. Proposed pathophysiological mechanisms include a pro-inflammatory state after surgery, leading to altered peripheral and central sensitization, genomic factors, epigenetic modifications, and altered brain physiology associated with chronic pain. Understanding the pathophysiology helps target interventions for pre-existing pain, surgery-related pain, anxiety, and opioid-induced hyperalgesia. Preoperative protocolized analgesic strategies, cognitive behavioral therapy, and acupuncture have been tried with varied success rates, although concrete data are lacking. The literature on regional analgesia is still limited in the pediatric population and represents a potential area for further research. Furthermore, rehabilitation interventions addressing postoperative trajectories with early referral to transitional pain clinics may offer promising avenues for improving outcomes. There is a significant knowledge gap, a scarcity of available data on CPSP, and difficulties in addressing pain in the pediatric population, underscoring the need for this review.
Core Tip: Chronic postsurgical pain (CPSP) may occur in up to 80% of the pediatric population. It is more severe after high-risk surgeries, such as spinal surgery, hernia repair, and thoracotomy. Potential risk factors in the pediatric population include psychosocial behaviors, pre-existing pain, postsurgical pain intensity, and the type of surgery performed. Proposed pathophysiological mechanisms include a proinflammatory state leading to altered peripheral and central sensitization, genomic factors, epigenetic modifications, and altered brain physiology associated with chronic pain. Preoperative protocolized analgesic strategies, cognitive behavioral therapy, and acupuncture have been attempted with varied success rates. Despite growing recognition of CPSP in children, a significant knowledge gap remains, which we aim to address in this review.
