Objective: Ineffective pediatric post-operative pain management increases the risk of Chronic Post-Surgical Pain (CPSP), affecting around 20% of children undergoing major surgery. Psychological predictors of recovery, in both children and their parents, have been identified. However, how these variables change throughout the recovery process remains unclear. The aim of the present study was to investigate the associations of adolescent and parental risk and resilience variables in everyday life, during post-operative recovery, for adolescents undergoing spinal fusion surgery.

Methods: Participants were adolescents with Idiopathic Scoliosis (AIS), aged 12-18 years, undergoing spinal fusion surgery, and their parents, recruited at four hospitals in Belgium. Participants completed daily assessments for 7 consecutive days, at 5 time-points, before surgery, and at 3 and 6 weeks, and 6 and 12 months, post-surgery. Diary measures included adolescent and parental pain and recovery variables known to be relevant in the context of pediatric post-operative pain. Network analysis was used to explore correlations between all variables throughout the post-operative recovery process.

Results: The sample comprised N=190 participants. Associations were stronger within adolescent and parent variables, than between them. For adolescents, psychological flexibility was associated with positive mood and activity engagement, and pain intensity with pain catastrophizing and activity avoidance. For parents, higher levels of pain-related fear and catastrophizing were related to more parent-to- child instructions to avoid activities. Regarding adolescent-parent between correlations, parental instructions to avoid activities were associated with adolescent physical complaints and activity avoidance, and parent pain catastrophizing was associated with adolescent pain- related fear and catastrophizing. Generally, networks displayed both similarities and differences across post-operative phases.

Discussion: The study sample was small in relation to the statistical analyses conducted. Even so, the present findings provide a new perspective on psychological predictors at play in everyday life throughout the pediatric post-operative recovery process, indicating important targets, both clinical and for future investigation.