Voepel-Lewis Terri, Caird Michelle S, Tait Alan R, Farley Frances A, Li Ying, Malviya Shobha, Hassett Afton, Weber Monica, Currier Emily, de Sibour Trevor, Clauw Daniel J
Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan.
Paediatr Anaesth. 2018 Oct;28(10):873-880. doi: 10.1111/pan.13467.
Persistent postoperative pain is a significant problem for many children, particularly for those undergoing major surgery such as posterior spine fusion. More than two-thirds report persistent pain after spine fusion, yet factors that may contribute to poorer outcomes remain poorly understood.
This prospective, longitudinal study examined how psychologic and somatic symptoms cluster together in children aged 10-17 years with idiopathic scoliosis, and tested the hypothesis that a higher psychological and somatic symptom cluster would predict worse pain outcomes 1 year after fusion.
Otherwise healthy children with idiopathic scoliosis completed preoperative surveys measuring recent pain intensity, pain location(s), somatic symptom severity, painDETECT (neuropathic-type pain symptoms), pain interference, fatigue, depression, anxiety, and pain catastrophizing. Pain outcome data were collected during hospitalization, and at 1 year after surgery.
Ninety-five children completed baseline surveys and a cluster analysis differentiated 28 (30%) with a high symptom profile that included; higher depression, fatigue, pain interference, catastrophizing, and painDETECT scores. High symptom cluster membership independently predicted higher pain interference at 1 year (β 9.92 [95% CI 6.63, 13.2], P < 0.001). Furthermore, children in this high symptom cluster reported significantly higher pain intensity and painDETECT scores, and had a 50% higher probability of continued analgesic use at 1 year compared to those in the Low Symptom Cluster (95% CI 21.3-78.5, P = 0.001).
Findings from this exploratory study suggest a need to comprehensively assess children with scoliosis for preoperative signs and symptoms that may indicate an underlying vulnerability for persistent pain. This, in turn may help guide a comprehensive perioperative treatment strategy to mitigate the potential for long-term pain trajectories.
术后持续性疼痛是许多儿童面临的重大问题，尤其是对于那些接受诸如后路脊柱融合术等大型手术的儿童。超过三分之二的儿童在脊柱融合术后报告有持续性疼痛，但可能导致较差预后的因素仍知之甚少。
这项前瞻性纵向研究考察了10至17岁特发性脊柱侧弯儿童的心理和躯体症状如何聚集在一起，并检验了以下假设：较高的心理和躯体症状聚集会预测融合术后1年更差的疼痛预后。
其他方面健康的特发性脊柱侧弯儿童完成术前调查，测量近期疼痛强度、疼痛部位、躯体症状严重程度、疼痛DETECT（神经性疼痛症状）、疼痛干扰、疲劳、抑郁、焦虑和疼痛灾难化。在住院期间以及术后1年收集疼痛预后数据。
95名儿童完成了基线调查，聚类分析区分出28名（30%）症状特征较高的儿童，这些特征包括：更高的抑郁、疲劳、疼痛干扰、灾难化和疼痛DETECT评分。高症状聚类成员独立预测1年时更高的疼痛干扰（β9.92 [95%CI 6.63, 13.2]，P < 0.001）。此外，与低症状聚类的儿童相比，该高症状聚类中的儿童报告的疼痛强度和疼痛DETECT评分显著更高，且1年时持续使用镇痛药的可能性高出50%（95%CI 21.3 - 78.5，P = 0.001）。
这项探索性研究的结果表明，有必要对脊柱侧弯儿童进行全面评估，以了解可能表明存在持续性疼痛潜在易感性的术前体征和症状。这反过来可能有助于指导全面的围手术期治疗策略，以降低长期疼痛轨迹的可能性。
