Factors affecting the experience of procedural and postoperative pain in children and adolescents - a systematic review

Abstract Aim To conduct a systematic review of factors contributing to 3–18-year-old children’s and adolescents’ experiences of procedural and postoperative pain. Materials and methods A PECO protocol was constructed. Searches were conducted in PubMed, CINAHL, PsycINFO, and Web of Science, up to January 2026. The researchers (reading in pairs) assessed identified studies independently, according to the defined inclusion and exclusion criteria. The report followed the PRISMA statement. Results Ten thousand, seven hundred twenty records were screened, 109 reports read in full text, and finally 18 articles were evaluated for risk of bias. Eight studies based on seven study populations were judged to have low or moderate overall risk of bias and were included in the review. These studies investigated whether the following exposure factors can influence pain experiences in children and adolescents: sex, age, dental anxiety, personal traits, parental anxiety, previous painful experiences, and genotype. For the factors sex, age and dental fear and anxiety, which were studied in at least two studies, synthesis without meta-analysis (SWiM) were conducted, and the certainty of evidence in the findings was determined using GRADE. The results show that there is a low certainty of evidence that female adolescents (12–18 years) rate procedural or postoperative pain higher than males. Furthermore, there is a very low certainty of evidence regarding the findings concerning age and dental anxiety. Consequently, the findings should be interpreted with caution. Ethical concerns were highlighted, as three of the eight included studies lacked complete information on ethical review and informed consent procedures. Conclusions Although several factors may be associated with children’s and adolescents’ pain experiences in conjunction with dental and medical treatment, the available evidence remains limited and the present review’s results should be interpreted with caution. The results imply that pain may be multifactorial which calls for individualised care. Trial registration The study protocol was registered in PROSPERO (CRD42022342566), available at https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022342566 .