Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
J Pain. 2013 Dec;14(12):1694-702. doi: 10.1016/j.jpain.2013.09.005.
Factors contributing to pain following surgery are poorly understood, with previous research largely focused on adults. With approximately 6 million children undergoing surgery each year, there is a need to study pediatric persistent postsurgical pain. The present study includes patients with adolescent idiopathic scoliosis undergoing spinal fusion surgery enrolled in a prospective, multicentered registry examining postsurgical outcomes. The Scoliosis Research Society Questionnaire-Version 30, which includes pain, activity, mental health, and self-image subscales, was administered to 190 patients prior to surgery and at 1 and 2 years postsurgery. A subset (n = 77) completed 5-year postsurgery data. Pain prevalence at each time point and longitudinal trajectories of pain outcomes derived from SAS PROC TRAJ were examined using analyses of variance and post hoc pairwise analyses across groups. Thirty-five percent of patients reported pain in the moderate to severe range presurgery. One year postoperation, 11% reported pain in this range, whereas 15% reported pain at 2 years postsurgery. At 5 years postsurgery, 15% of patients reported pain in the moderate to severe range. Among the 5 empirically derived pain trajectories, there were significant differences on self-image, mental health, and age. Identifying predictors of poor long-term outcomes in children with postsurgical pain may prevent the development of chronic pain into adulthood.
This investigation explores the prevalence of pediatric pain following surgery, up to 5 years after spinal fusion surgery. Five pain trajectories were identified and were distinguishable on presurgical characteristics of age, mental health, and self-image. This is the largest study to examine longitudinal pediatric pain trajectories after surgery.
导致手术后疼痛的因素尚未被充分了解，既往研究主要集中在成年人。每年约有 600 万儿童接受手术，因此有必要研究儿童持续性手术后疼痛。本研究纳入了接受脊柱融合手术的青少年特发性脊柱侧凸患者，这些患者参与了一项前瞻性、多中心登记研究，旨在评估手术后的结果。使用脊柱侧凸研究协会问卷-第 30 版（SRS-30），在手术前、手术后 1 年和 2 年评估患者的疼痛、活动、心理健康和自我形象等方面。其中 77 名患者完成了 5 年的随访。使用方差分析和组间事后两两比较，分析了各时间点的疼痛发生率和疼痛结局的纵向轨迹。术前有 35%的患者报告疼痛处于中度至重度范围。术后 1 年，11%的患者报告处于该范围，而术后 2 年，15%的患者报告疼痛。术后 5 年，15%的患者报告疼痛处于中度至重度范围。在 5 种经验衍生的疼痛轨迹中，自我形象、心理健康和年龄存在显著差异。识别术后疼痛儿童的长期不良结局的预测因素可能有助于预防慢性疼痛发展为成年期疼痛。
本研究探讨了脊柱融合手术后儿童疼痛的发生率，随访时间最长可达 5 年。确定了 5 种疼痛轨迹，这些轨迹在手术前的年龄、心理健康和自我形象特征上存在差异。这是研究手术后儿童纵向疼痛轨迹的最大规模研究。
