ArticleThe journal of pain2026
Pre-surgical quantitative sensory testing and post-surgical pain among adolescents undergoing spinal fusion surgery: A longitudinal cohort study.
Article in The journal of pain, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Pediatric post-surgical pain is common and associated with diminished quality of life and significant medical costs. While quantitative sensory testing (QST) is a promising tool for predicting post-surgical pain in adults, research in youth is lacking. We tested associations between pre-surgical QST indices (pressure and heat pain thresholds, mechanical temporal summation of pain [MTSP], conditioned pain modulation, and cold-pressor painful after-sensations) and average and worst pain severity and pain interference assessed daily during the first week post-hospital discharge (acute outcomes), as well as six-month post-surgical pain intensity and presence of chronic post-surgical pain (CPSP; six-month pain intensity>3/10 and quality-of-life score<74.9). Of 160 enrolled participants, 142 (mean age=14.6 years, 76% female) who completed QST and outcome measures were analyzed. Mean average and worst acute pain severity across the first seven days were 3.5/10 and 5.5/10. Six-month pain intensity was 2.7/10; 30.6% of participants had CPSP. Controlling for sociodemographic and pre-surgical characteristics, higher MTSP (b=0.17, 95% CI=0.02-0.32) and painful after-sensations (b=0.13, 95% CI=0.02-0.23) were associated with greater average acute pain severity. Higher MTSP was also associated with greater worst acute pain severity (b=0.30, 95% CI=0.12-0.47) and six-month pain intensity (b=0.36, 95% CI=0.16-0.55). No QST indices were associated with CPSP. Exploratory analyses revealed that associations were stronger for youth with mild pre-surgical pain. Results suggest QST, particularly MTSP, is a promising pre-surgical marker to identify adolescents who may experience greater post-surgical pain. Future research should evaluate feasibility of pre-surgical bedside QST and QST as a predictor of responsiveness to post-surgical pain management interventions. PERSPECTIVE: Results from this prospective longitudinal study, the largest to date employing preoperative quantitative sensory testing (QST) in adolescents, suggest that pre-surgical QST, particularly mechanical temporal summation of pain, is a promising marker for identifying adolescents at risk for severe acute post-surgical pain.
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