# Mechanisms of transition from acute to chronic pain in youth undergoing musculoskeletal surgery

> **NIH NIH R01** · SEATTLE CHILDREN'S HOSPITAL · 2021 · $589,465

## Abstract

Chronic postsurgical pain (CPSP) has been recognized as a major health concern across the lifespan.
Adolescents undergoing invasive musculoskeletal surgeries are particularly at risk for CPSP, which occurs in
about 20% of youth after surgery. CPSP is associated with significant functional disability and reduced physical
and psychosocial health-related quality of life. Chronic pain in adolescence also places individuals at risk for
chronic pain in adulthood, as well as risk for substance use disorder, generating potential lifelong
consequences on functioning, productivity, and quality of life. In our own preliminary studies in a small sample
of adolescents having major surgery, we demonstrated that (1) youth who develop CPSP may follow distinct
recovery patterns that emerge within the first 2 weeks following surgery, and (2) baseline psychosocial risk
factors predict development of CPSP. However, further studies are needed to understand recovery during the
initial weeks following surgery when acute postsurgical pain begins to transition to CPSP. Although there is
indication from prior studies that psychosocial factors may play a role in CPSP, there has been limited data on
further biopsychosocial mechanisms that influence the transition from acute to chronic pain after
musculoskeletal surgery in adolescents. These gaps in knowledge have limited the development and
implementation of perioperative interventions targeted at the mechanisms of the transition from acute to CPSP
to positively alter the trajectory of postsurgical recovery. Thus, this project aims to 1) develop valid and reliable
acute recovery indices using short-term trajectories of pain, sleep quality, mood, and physical function over the
first 30 days following spinal fusion surgery, and 2) determine the psychosocial and psychophysical
mechanisms contributing to the transition from acute to chronic postsurgical pain. To address these aims, we
propose a 2-site prospective longitudinal cohort study in 160 youth aged 10 to 18 years undergoing spinal
fusion surgery, and their parents. Prospective assessments of pain, health, and functional outcomes will be
collected before surgery and at three time points during the 6 months after surgery. Immediately after surgery,
adolescents will complete daily monitoring of pain, sleep quality, mood, and physical function in the first 30
days following hospital discharge using ecological momentary assessment. These data will be used to develop
valid and reliable acute recovery indices that predict CPSP at 3 and 6 months post-surgery. We will measure
two potential sets of mechanisms underlying the transition from acute to CPSP, psychosocial variables and
laboratory-based psychophysical pain responses, before surgery and at 8-weeks post-surgery in order to
determine the temporal influence on subsequent development of CPSP. This study will increase understanding
of the transition from acute to chronic postsurgical pain and the causal mechanisms involved. ...

## Key facts

- **NIH application ID:** 10213656
- **Project number:** 5R01AR073780-04
- **Recipient organization:** SEATTLE CHILDREN'S HOSPITAL
- **Principal Investigator:** Jennifer Rabbitts
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $589,465
- **Award type:** 5
- **Project period:** 2018-07-12 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10213656

## Citation

> US National Institutes of Health, RePORTER application 10213656, Mechanisms of transition from acute to chronic pain in youth undergoing musculoskeletal surgery (5R01AR073780-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10213656. Licensed CC0.

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