Distinct Biopsychosocial Phenotypes in Young Adults with Chronic Postsurgical Pain

Overview

This study identified two distinct phenotypes of chronic postsurgical pain (CPSP) in adolescents and young adults (AYAs), characterized by differences in psychological distress, autonomic reactivity, neuroendocrine markers, and resting-state cortical activity. Despite similar physical performance, AYAs with CPSP exhibited greater pain interference and dysregulated physiological responses compared to healthy controls.

Background

Chronic postsurgical pain affects approximately 10%–20% of AYAs following major surgeries and is linked to significant functional impairments and emotional distress. The transition from adolescence to young adulthood is a critical period during which CPSP may induce long-lasting neurobiological and psychosocial changes, increasing vulnerability to persistent pain and mood disorders. Chronic stress and HPA axis dysregulation play pivotal roles in CPSP development, influencing brain circuits involved in pain modulation and emotional regulation. Physical functioning is thought to buffer these effects by promoting healthier stress physiology and adaptive neurocognitive patterns.

Data Highlights

Key Findings

• AYAs with CPSP reported significantly greater pain interference despite similar objective physical performance compared to healthy controls.
• Psychological distress, hair cortisol concentration, physical performance, and resting-state prefrontal and somatosensory cortex activity were significantly interrelated within the CPSP group.
• Two distinct CPSP phenotypes were identified: low functioning and high functioning, differing in pain catastrophizing, autonomic reactivity, and somatosensory cortex activity.
• CPSP is associated with distinct autonomic, neuroendocrine, and cortical signatures that co-vary with functional performance.
• Higher physical functioning is linked to more adaptive neurocognitive regulation and may buffer the impact of chronic stress on pain and emotional health.

Clinical Implications

Integrating physiological biomarkers and resting-state neuroimaging with performance-based assessments can enhance mechanistic understanding and phenotyping of CPSP in AYAs. Identifying distinct phenotypes may guide personalized rehabilitation strategies targeting psychological distress, autonomic dysregulation, and cortical activity to improve functional outcomes. Clinicians should consider multidimensional assessments beyond pain severity to optimize management of CPSP.

Conclusion

CPSP in young adults manifests with heterogeneous biopsychosocial profiles that relate to functional capacity and neurobiological regulation. Multimodal phenotyping approaches hold promise for advancing targeted interventions and improving long-term outcomes in this vulnerable population.

References

1. Author/Source/2024 -- Identification of Distinct Biopsychosocial Phenotypes in Young Adults with Chronic Postsurgical Pain