Chronic postsurgical pain in children: Current evidence and clinical perspectives

Table 4 Phenotypes of chronic postsurgical pain in children

Type of CPSP	Key characteristics	Symptoms	Onset and course	Surgeries/contexts
Neuropathic CPSP	Pain from nerve injury. Sensory abnormalities present	Burning; shooting/electric; tingling/numbness; allodynia/hyperalgesia	Often immediate or early after surgery, can persist or worsen if untreated	Amputation; thoracotomy; spinal surgery; limb-sparing surgery
Nociceptive CPSP	Pain from ongoing tissue inflammation/damage. Movement-related	Aching; throbbing; sharp with movement	Correlates with tissue healing; may improve slowly or plateau	Orthopedic procedures; major abdomen and chest surgeries
Mixed CPSP	Combination of neuropathic + nociceptive features. Most common presentation	Variable: Aching + burning. Movement-induced shooting pain	Mixed timeline; inflammatory component may reduce, neuropathic may persist	Spinal fusion; major oncologic resection
Phantom limb pain	Pain perceived in absent limb. Often neuropathic mechanism	Cramping; twisting; burning in “phantom”	Within days to weeks after amputation; can become chronic	Amputation
Stump pain	Pain at amputation residual limb. Can be neuropathic or nociceptive	Tenderness; burning at incision/scar; shock-like jolts	Early postoperative; may evolve into neuroma pain	After amputation; following limb disarticulation
Central sensitization-mediated CPSP	Amplified pain due to CNS maladaptation. Widespread hyperalgesia	Diffuse sensitivity. Disproportionate to exam	Postoperative onset; associated with high acute pain	After major surgeries; preoperative anxiety/pain
Visceral CPSP	Poorly localized, deep pain. Often referred patterns	Cramping; pressure; deep aching	May appear after initial recovery; triggered by organ distension	Abdominal/pelvic surgery

CNS: Central nervous system; CPSP: Chronic postsurgical pain.