Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
Paediatr Anaesth. 2020 Dec;30(12):1340-1347. doi: 10.1111/pan.14031. Epub 2020 Nov 7.
Both parental and child factors have been previously associated with persistent or recurrent postoperative pain in children. Yet, little is known about the relative contribution of parent factors or whether child symptom factors might impact the association between parent factors and long-term pain. The aim of this study was to explore the associations between parent factors, child symptomology, and the child's long-term pain outcomes after surgery.
This prospective, longitudinal study included parents and their children who were scheduled to undergo spinal fusion for underlying scoliosis. Parents completed baseline surveys about their pain history, pain relief preferences (ie, preference to relieve their child's pain vs avoid analgesic risks), and pain catastrophizing (ie, beliefs about their child's pain). Children were classified previously into high vs low symptom profiles at baseline based on their self-reported pain, catastrophizing, fatigue, depression, and anxiety. Children were assessed 1-year after surgery for their long-term pain interference scores and analgesic use. Serial regression modeling was used to explore whether associations between parent factors and the outcomes were changed when accounting for child factors.
Seventy-six parent/child dyads completed all surveys. Parental preferences and catastrophizing were atemporally associated with the child's baseline psychological-somatic symptom profile. Though parent and child factors were both associated with the long-term pain outcomes, when all three factors were accounted for, the associations between parent factors and long-term pain was fully attenuated by the child's profile.
These findings suggest that the relationship between parent factors and long-term postoperative pain outcomes may be dependent on the child's symptom profile at baseline. Since there may be bidirectional relationships between parent and child factors, interventions to mitigate long-term pain should address child symptoms as well as parental factors.
父母和儿童因素都与儿童术后持续性或复发性疼痛有关。然而，对于父母因素的相对贡献，或者儿童症状因素是否会影响父母因素与长期疼痛之间的关联，我们知之甚少。本研究旨在探讨父母因素、儿童症状学与儿童术后长期疼痛结局之间的关系。
这是一项前瞻性、纵向研究，纳入了计划接受脊柱融合术治疗脊柱侧凸的父母及其子女。父母在基线时完成了关于疼痛史、止痛偏好（即缓解孩子疼痛与避免止痛风险的偏好）和疼痛灾难化（即对孩子疼痛的信念）的问卷调查。根据孩子自我报告的疼痛、灾难化、疲劳、抑郁和焦虑，孩子在基线时被分为高症状和低症状特征。在术后 1 年评估孩子的长期疼痛干扰评分和止痛药物使用情况。采用序列回归模型来探讨当考虑到儿童因素时，父母因素与结局之间的关联是否发生变化。
76 对父母/子女完成了所有的调查。父母的偏好和灾难化与孩子的基线心理躯体症状特征具有时间相关性。尽管父母和孩子的因素都与长期疼痛结局有关，但当考虑到所有三个因素时，父母因素与长期疼痛之间的关联完全被孩子的特征所减弱。
这些发现表明，父母因素与术后长期疼痛结局之间的关系可能取决于孩子基线时的症状特征。由于父母和孩子的因素之间可能存在双向关系，因此减轻长期疼痛的干预措施应同时针对儿童的症状和父母的因素。
