Parental anxiety and catastrophizing in pediatric tonsillectomy pain control: A multivariate analysis

Objective: Parental anxiety and/or catastrophizing may bias the interpretation of children's pain , adminis- tration of analgesia post-tonsillectomy. We aimed to determine whether high levels of parental anxiety and/or catastrophizing impact child pain intensity interpretation and administration of analgesia. Methods: Child-parent dyads were recruited from a tertiary care institution between July 2017-December 2019. Preoperative parental anxiety and catastrophizing were assessed using self-report measures. Postoperative data on child and parent pain intensity, as well as analgesia use, were collected up to 2 weeks post-surgery. Multi- variable logistic regression models were created to assess predictors of postoperative child pain intensity and analgesia use. Results: Our cohort included 234 child-parent dyads. Median child age was 5 years (IQR, 4-6) , 9.0 % of children (n = 21) had a medical comorbidity. Both child- and parent-reported pain intensity were highest on postoperative day 2 (3.65 [SD = 3.08] and 3.67 [SD = 2.51], respectively). Parental catastrophizing did not predict analgesia use at home, although a minimal significant decrease in the odds of analgesia administration was observed on postoperative day 7 (OR 0.932, p = 0.017). Maximal parental anxiety did not predict higher odds of increased child postoperative pain intensity on any postoperative day. Conclusion: Parental catastrophizing prior to tonsillectomy has minimal predictive value for analgesia use postoperatively. Children may be successfully advocating for their own pain control as parental anxiety and catastrophizing do not appear to be unduly influencing analgesia administration. Future studies should explore the impact of parental anxiety on vulnerable pediatric populations who may be unable to self-advocate for pain management.