Abstract
Objectives Acute pain trajectories are associated with long-term outcomes such as persistent pain and functional disability in adults. However, there are limited data on acute postoperative pain trajectories in the pediatric population. The aims of this study were to investigate acute postoperative pain trajectories, their predictors, and their impact on long- term outcomes in adolescents with idiopathic scoliosis. Methods We evaluated the preoperative pain intensity, use of analgesics, psychosocial measures and physical functioning of adolescents scheduled to undergo spinal fusion, and their average 6-hour self-reported pain intensity scores for their entire hospital stay. Six months after surgery, baseline variables were reassessed. We used growth mixture modeling to conduct acute postoperative pain trajectory analysis and to identify predictors of pain trajectories. Generalized linear models were conducted to determine whether acute pain trajectories predict long-term outcomes. Results One hundred and six patients were included in the best-fitted acute pain trajectory model that included four classes that differed in initial pain intensity and rates of change over time. Preoperative pain catastrophizer status and use of analgesics significantly predicted pain trajectory membership. Furthermore, at the 6-month follow-up, patients experiencing moderate-to-severe pain in the acute postoperative period were more likely to report higher levels of pain severity, use pain medication, and miss a greater number of school/work days due to back pain in the last three months. Discussion. Preoperative assessment and analyzing the progression of pain in the acute postoperative period can help identify those at risk of negative long-term outcomes after surgery.
Highlights
Chronic postsurgical pain is defined as pain that persists for over three months, well after the surgical tissues have healed [1]
Spinal fusion surgery with instrumentation is performed on pediatric patients with adolescent idiopathic scoliosis (AIS), a 3-dimensional deformity of the spine with pronounced single or double curving of the spine [2]
Our findings revealed that patients experiencing mild pain in the acute postoperative period were low-opioid consumers, while those experiencing moderate pain were high-opioid consumers
Summary
Chronic postsurgical pain is defined as pain that persists for over three months, well after the surgical tissues have healed [1]. Spinal fusion surgery with instrumentation is performed on pediatric patients with adolescent idiopathic scoliosis (AIS), a 3-dimensional deformity of the spine with pronounced single or double curving of the spine [2]. Spinal fusion surgery with instrumentation is an invasive and extensive surgery such that persistent pain is a common postoperative complication [3]. Acute postsurgical pain has been shown to predict chronic pain and opioid use in children and adolescents [6, 7]. The persistent nature of postoperative pain may delay rehabilitation [4, 8]. E days following surgery are a critical period where the dynamism of acute pain has an impact on long-term outcomes. While pain was considered in relation to time, enormous variability existed in the outcomes at each time point, suggesting heterogeneity of the study population and the presence of multiple subgroups
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