Predicting the pain continuum after adolescent idiopathic scoliosis surgery: A prospective cohort study

Abstract

Background Chronic postsurgical pain (CPSP) affects half a million children annually in the United States, with dire socioeconomic consequences, including long-term disability into adulthood. The few studies of CPSP in children are limited by sample size, follow-up duration, non-homogeneity of surgical procedure and factors evaluated. Methods In a prospective study of 144 adolescents undergoing a single major surgery (spine fusion), we evaluated demographic, perioperative, surgical and psychosocial factors as predictors of a continuum of postsurgical pain: immediate, pain maintenance at 2–3 months (chronic pain/CP) and persistence of pain a year (persistent pain/PP) after surgery. Results We found an incidence of 37.8% and 41.8% for CP and PP. CP and acute pain were both significant predictors for developing PP (p-value <0.001 and 0.003). Preoperative pain and higher postoperative opioid requirement was significantly associated with CP (p = 0.015, p = 0.002), while Childhood Anxiety Sensitivity Index (p = 0.002) and surgical duration (p = 0.014) predicted PP. The final regression models had reasonable predictive accuracy (c-statistic of 0.73 and 0.83 for CP and PP, respectively). Anxiety scores and catastrophizing for child and parent were found to be significantly correlated (p = 0.005, p = 0.013 respectively). Pain trajectories revealed that 65% of patients who developed PP reported CP and high pain trends; however, 33% of those who developed PP could not be identified using solely pain criteria. Conclusion Persistent postsurgical pain in children is a significant problem. It can be predicted in part by combinations of psychological and clinical variables, which may provide evidence-based measures to prevent development of CPSP in the future. Significance In a homogeneous cohort of adolescents undergoing spine fusion, we report a high incidence of persistent postsurgical pain (41.8%) predicted by child anxiety, perioperative pain, and surgical duration. Our results stress timely preventive and therapeutic strategies.

DNA methylation at the mu-1 opioid receptor gene (<em>OPRM1</em>) promoter predicts preoperative, acute, and chronic postsurgical pain after spine fusion

“…It has been previously shown that psychological and clinical variables contribute to CPSP 31. This study finds associations between epigenetics and CPSP in children for the first time and adds to the emerging evidence linking epigenetic mechanisms to the development of chronic pain states 41.…”

“…Demographics and patients’ clinical characteristics were summarized as mean (standard deviation [SD]), median, and frequency (percentage) according to the distribution of the data. Prior to evaluation of the association between pain outcome and DNA methylation, the effects of covariables were tested, which included age, sex, race, morphine dose in mg/kg on POD 1 and 2, preoperative anxiety score (VAS), preoperative pain score, duration of surgery, vertebral levels fused, propofol and remifentanil doses used during surgery (per kg), use of intravenous acetaminophen/ketorolac (yes/no), diazepam doses (mg/kg), and pain catastrophizing scale (parent version) and parent pain history scores and sequential scores for Childhood Anxiety Sensitivity Index and pain catastrophizing scale (child version) 31. Three pain outcomes were examined.…”

A cluster of high psychological and somatic symptoms in children with idiopathic scoliosis predicts persistent pain and analgesic use 1 year after spine fusion

“…This discrepancy in findings may be due to the presence and stronger predictive value of the baseline cluster of psychological and somatic symptoms (ie, depression, fatigue, pain worry, neuropathic‐like symptoms). Others have similarly found strong and independent associations between psychological characteristics such as “anxiety sensitivity”, child pain catastrophizing and long‐term postoperative pain outcomes. Our data provide a more comprehensive description of the psychological and somatic characteristics that may cluster together to predict long‐term pain trajectories after surgery.…”

Perioperative factors associated with persistent opioid use after extensive abdominal surgery in children and adolescents: A retrospective cohort study

“…In this retrospective study of children and adolescents who had undergone extensive abdominal surgery, over a third of the patients reported persistent opioid use up to 6 months after surgery, and approximately one out of every ten children were still taking opioids 2 years after surgery. This rate of persistent opioid use was higher than those reported in the pediatric nononcologic surgical population . For comparison, the reported rates of persistent opioid use in children who have undergone scoliosis surgery range from less than 1% to 11% .…”