Clinical Scorecard: Identification of Distinct Biopsychosocial Phenotypes in Young Adults with Chronic Postsurgical Pain through Resting-State Cortical Activity, Biomarkers, and Functional Performance

At a Glance

Key Highlights

• AYAs with CPSP show greater pain interference and dysregulated physiological responses despite similar objective physical performance compared to healthy controls.
• Psychological distress, hair cortisol concentration, physical performance, and resting-state cortical activity are interrelated within the CPSP group.
• Two distinct CPSP phenotypes (low functioning and high functioning) differ in pain catastrophizing, autonomic reactivity, and somatosensory cortex resting-state activity.

Guideline-Based Recommendations

Diagnosis

• Assess psychological symptoms and pain interference using standardized self-report measures.
• Evaluate physical performance objectively (e.g., 1-minute sit-to-stand test) alongside physiological responses to exertion.
• Incorporate resting-state cortical hemodynamic activity assessment (e.g., fNIRS) to identify neurobiological signatures.

Management

• Integrate physiological biomarkers and neuroimaging with performance-based assessments to tailor rehabilitation strategies.
• Promote physical activity to enhance physical functioning, which may improve stress physiology and emotional regulation.
• Address psychological distress and pain catastrophizing to improve functional outcomes.

Monitoring & Follow-up

• Monitor changes in pain interference, psychological distress, and physical performance over time.
• Track neuroendocrine markers such as hair cortisol concentration to assess stress regulation.
• Use neuroimaging biomarkers to evaluate cortical activity patterns related to pain and function.

Risks

• Persistent CPSP during adolescence and young adulthood may increase vulnerability to long-term functional disability and mood/anxiety disorders.
• Dysregulated HPA axis and cortical activity can exacerbate pain and emotional distress.
• Low physical functioning may reinforce maladaptive neurobiological and psychosocial trajectories.

Patient & Prescribing Data

Adolescents and young adults aged 18–30 years with chronic postsurgical pain

Phenotyping CPSP patients by integrating psychological, physiological, and neurobiological data can guide personalized rehabilitation focusing on improving physical function and stress regulation.

Clinical Best Practices

• Use multidimensional assessment combining psychological, physiological, and neuroimaging measures for comprehensive CPSP evaluation.
• Identify distinct phenotypes to tailor interventions targeting specific biopsychosocial profiles.
• Encourage regular physical activity to support neurocognitive and emotional regulation mechanisms.
• Address chronic stress and HPA axis dysregulation as part of pain management strategies.

References

• Chronic pain prevalence and impact in AYAs
• CPSP definition and epidemiology
• Role of physical activity in pain resilience
• Neuroimaging correlates of physical functioning in chronic pain