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Cited by 130Pediatric Pain Management TechniquesAnesthesia and Pain ManagementPain Management and Treatment

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

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Chidambaran, V., Ding, L., Moore, D.L., Spruance, K., Cudilo, E.M., Pilipenko, V., Hossain, M., Sturm, P. +3 more·2017·European Journal of Pain
DOI 10.1002/ejp.1025PMC PMC5541247
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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.

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  • Higher consumption of postoperative analgesics is associated with more intense chronic postsurgical pain.

    “Higher consumption of postoperative analgesics, typically a proxy for intense postoperative pain, is associated with more intense CPSP.38,40,41”

    From Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service (2019) · cites this paper as [38]

    Results §3.5 reports that greater morphine consumption on postoperative days 1–2 predicted chronic pain at 2–3 months. Methods §2.3 defines that outcome as pain rated at least 4/10 after adolescent scoliosis surgery; the paper does not establish that greater analgesic consumption predicts progressively more intense chronic pain. (LLM, conf=0.86)

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  • Pain intensity in the weeks after surgery reliably predicts chronic postsurgical pain.

    “The data clearly show that the presence32 and intensity of preoperative chronic pain,6,33–35 the intensity of acute postoperative pain,6,23,32,33,36 the time spent in severe pain after surgery,6 pain intensity in the weeks after surgery,35,37,38 and pain in other body parts32,34,39 reliably predict CPSP across a range of surgical procedures.”

    From Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service (2019) · cites this paper as [38]

    The Discussion reports a prior study in which pain two weeks after discharge predicted chronic postsurgical pain, and Results §3.6 finds that pain in the first two postoperative days predicted pain persistence in this cohort of adolescents undergoing spine fusion. But this cohort did not measure pain intensity in the intervening weeks; the Discussion also notes that 33% of patients who developed persistent pain did not follow the early-pain pattern. The source therefore does not establish that pain intensity in the weeks after surgery reliably predicts chronic pain across surgical procedures. (LLM, conf=0.85)

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Authors
Chidambaran, V., Ding, L., Moore, D. L., Spruance, K., Cudilo, E. M., Pilipenko, V., Hossain, M., Sturm, P., Kashikar‐Zuck, S., Martin, L. J., & Sadhasivam, S.
Affiliations
  • Cincinnati Children's Hospital Medical Center (US)
  • Pediatric Anesthesia Associates Medical Group Fresno CA
Corresponding author
Chidambaran, V.
ORCID
Venue
European Journal of Pain
Publisher
Wiley
Published
2017-03-27
Volume
21
Issue
7
Pages
1252-1265
ISSN
  • 1090-3801 (ISSN-L)
  • 1532-2149
DOI
10.1002/ejp.1025
PMC
PMC5541247
OpenAlex
W2599751576
Cited by
130
References
45
Citations by year
2026: 9 · 2025: 16 · 2024: 15 · 2023: 13 · 2022: 19 · 2021: 19 · 2020: 16 · 2019: 14 · 2018: 4 · 2017: 3
FWCI
11.05
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • European Journal of Pain (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (5K23HD082782)
  • National Institutes of Health (8 UL1 TR000077)
  • National Center for Research Resources
  • National Center for Advancing Translational Sciences
  • Anesthesia Patient Safety Foundation
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
chronic postoperative pain, adolescent idiopathic scoliosis, spinal fusion, pain prediction, preoperative pain, postoperative opioid requirement, anxiety sensitivity, pain catastrophizing, operative time, pain trajectories, pediatric pain
MeSH terms
Adolescent, Analgesics, Opioid, Anxiety, Child, Humans, Postoperative Pain, Pain, Postoperative, Parents, Prospective Studies, Scoliosis, Time Factors, Incidence, Catastrophization, Chronic Pain

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