Pavlova Maria, Lund Tatiana, Sun Jenny, Katz Joel, Brindle Mary, Noel Melanie
Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Can J Pain. 2022 Jun 9;6(2):152-165. doi: 10.1080/24740527.2022.2058919. eCollection 2022.
Three to 22% of youth undergoing surgery develop chronic postsurgical pain (CPSP). Negative biases in pain memories (i.e., recalling higher levels of pain as compared to initial reports) are a risk factor for CPSP development. Children's memories for pain are modifiable. Existing memory-reframing interventions reduced negatively biased memories associated with procedural pain and pain after minor surgery. However, not one study has tested the feasibility and acceptability of the memory-reframing intervention in youth undergoing major surgery.
The current pilot randomized clinical trial (RCT; NCT03110367; clinicaltrials.gov) examined the feasibility and acceptability of, as well as adherence to, a memory reframing intervention.
Youth undergoing a major surgery reported their baseline and postsurgery pain levels. Four weeks postsurgery, youth and one of their parents were randomized to receive control or memory-reframing instructions. Following the instructions, parents and youth reminisced about the surgery either as they normally would (control) or using the memory-reframing strategies (intervention). Six weeks postsurgery, youth completed a pain memory interview; parents reported intervention acceptability. Four months postsurgery, youth reported their pain.
Seventeen youth (76% girls, = 14.1 years) completed the study. The intervention was feasible and acceptable. Parents, but not youth, adhered to the intervention principles. The effect sizes of the intervention on youth pain memories ( = 0.22) and pain outcomes ( = 0.23) were used to inform a larger RCT sample size.
Memory reframing is a promising avenue in pediatric pain research. Larger RCTs are needed to determine intervention efficacy to improve pain outcomes.
接受手术的青少年中有3%至22%会发展为慢性术后疼痛（CPSP）。疼痛记忆中的负面偏差（即与最初报告相比回忆起更高水平的疼痛）是CPSP发展的一个风险因素。儿童对疼痛的记忆是可改变的。现有的记忆重构干预措施减少了与程序性疼痛和小手术后疼痛相关的负面偏差记忆。然而，没有一项研究测试过记忆重构干预措施在接受大手术的青少年中的可行性和可接受性。
当前的试点随机临床试验（RCT；NCT03110367；clinicaltrials.gov）研究了记忆重构干预措施的可行性、可接受性以及依从性。
接受大手术的青少年报告其基线和术后疼痛水平。术后四周，青少年及其父母之一被随机分配接受对照或记忆重构指导。按照指导，父母和青少年要么像往常一样回忆手术情况（对照），要么使用记忆重构策略（干预）。术后六周，青少年完成疼痛记忆访谈；父母报告干预的可接受性。术后四个月，青少年报告他们的疼痛情况。
17名青少年（76%为女孩，平均年龄 = 14.1岁）完成了研究。该干预措施是可行且可接受的。父母遵守了干预原则，但青少年没有。干预对青少年疼痛记忆（效应量 = 0.22）和疼痛结果（效应量 = 0.23）的影响大小被用于确定更大规模RCT的样本量。
记忆重构是儿科疼痛研究中一个有前景的方向。需要更大规模的RCT来确定干预效果以改善疼痛结果。
