Mallory Perry1, Christine B Sieberg2, Erin E Young3, Kyle Baumbauer4, Vijender Singh5, Cindy Wong6, Angela Starkweather7. 1. Center for the Advancement in Managing Pain, University of Connecticut School of Nursing, Storrs, Connecticut. Electronic address: perrym2@email.chop.edu. 2. Department of Anesthesiology, Critical Care, and Pain Medicine, Center for Pain and the Brain (P.A.I.N. Group), Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Biobehavioral Pediatric Pain Lab, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts. 3. Center for the Advancement in Managing Pain, University of Connecticut School of Nursing, Storrs, Connecticut; Department of Genetics and Genome Science, University of Connecticut School of Medicine, Storrs, Connecticut. 4. Center for the Advancement in Managing Pain, University of Connecticut School of Nursing, Storrs, Connecticut; Department of Neuroscience, University of Connecticut School of Medicine, Storrs, Connecticut. 5. Computational Biology Core, University of Connecticut Institute for Systems Genomics, Storrs, Connecticut. 6. Department of Psychiatry, Biobehavioral Pediatric Pain Lab, Boston Children's Hospital, Boston, Massachusetts. 7. Center for the Advancement in Managing Pain, University of Connecticut School of Nursing, Storrs, Connecticut.
Abstract
BACKGROUND: Adolescent idiopathic scoliosis is one of the most common spinal deformities in children and adolescents requiring extensive surgical intervention. Due to the nature of surgery, spinal fusion increases their risk of experiencing persistent postsurgical pain. Up to 20% of adolescents report pain for months or years after corrective spinal fusion surgery. AIMS: To examine the influence of preoperative psychosocial factors and mRNA expression profiles on persistent postoperative pain in adolescents undergoing corrective spinal fusion surgery. DESIGN: Prospective, longitudinal cohort study. SETTING: Two freestanding academic children's hospitals. METHODS: Utilizing a longitudinal approach, adolescents were evaluated at baseline (preoperatively) and postoperatively at ±1 month and ±4-6 months. Self-report of pain scores, the Pain Catastrophizing Scale-Child, and whole blood for RNA sequencing analysis were obtained at each time point. RESULTS: Of the adolescents enrolled in the study, 36% experienced persistent pain at final postoperative follow-up. The most significant predictors of persistent pain included preoperative pain severity and helplessness. Gene expression analysis identified HLA-DRB3 as having increased expression in children who experienced persistent pain postoperatively, as opposed to those whose pain resolved. A prospective validation study with a larger sample size is needed to confirm these findings. CONCLUSIONS: While adolescent idiopathic scoliosis is not often classified as a painful condition, providers must be cognizant of pre-existing pain and anxiety that may precipitate a negative recovery trajectory. Policy and practice change are essential for early identification and subsequent intervention.
BACKGROUND: Adolescent idiopathic scoliosis is one of the most common spinal deformities in children and adolescents requiring extensive surgical intervention. Due to the nature of surgery, spinal fusion increases their risk of experiencing persistent postsurgical pain. Up to 20% of adolescents report pain for months or years after corrective spinal fusion surgery. AIMS: To examine the influence of preoperative psychosocial factors and mRNA expression profiles on persistent postoperative pain in adolescents undergoing corrective spinal fusion surgery. DESIGN: Prospective, longitudinal cohort study. SETTING: Two freestanding academic children's hospitals. METHODS: Utilizing a longitudinal approach, adolescents were evaluated at baseline (preoperatively) and postoperatively at ±1 month and ±4-6 months. Self-report of pain scores, the Pain Catastrophizing Scale-Child, and whole blood for RNA sequencing analysis were obtained at each time point. RESULTS: Of the adolescents enrolled in the study, 36% experienced persistent pain at final postoperative follow-up. The most significant predictors of persistent pain included preoperative pain severity and helplessness. Gene expression analysis identified HLA-DRB3 as having increased expression in children who experienced persistent pain postoperatively, as opposed to those whose pain resolved. A prospective validation study with a larger sample size is needed to confirm these findings. CONCLUSIONS: While adolescent idiopathic scoliosis is not often classified as a painful condition, providers must be cognizant of pre-existing pain and anxiety that may precipitate a negative recovery trajectory. Policy and practice change are essential for early identification and subsequent intervention.
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