Boyer Elizabeth R, Corlett Allison G, Nickodem Kyle, Symons Frank J, Novacheck Tom F, Burkitt Chantel C
Department of Research, Gillette Children's, Saint Paul.
Department of Orthopedic Surgery, University of Minnesota-Twin Cities, Minneapolis, MN.
J Pediatr Orthop. 2025 Oct 1;45(9):531-539. doi: 10.1097/BPO.0000000000003005. Epub 2025 May 7.
Many children with cerebral palsy (CP) undergo orthopaedic surgery. Prospective studies exploring patient or psychological factors predictive of pain recovery or chronicity have not been investigated in CP and orthopaedic surgery. In studies with other pediatric clinical samples, preoperative pain, anxiety, and catastrophizing were shown to be predictive of pain outcomes. The purpose of this exploratory study was to (a) quantify pain presence longitudinally before and after orthopaedic surgery in children with CP and (b) identify preoperative factors associated with postoperative pain intensity and interference.
Parents of 36 children (mean age=12 y, range=4 to 17) completed online surveys at 1 week preoperative, and 1, 3, 6, and 12 months after spinal fusion (n=10), multilevel lower extremity surgery (n=20), or other orthopaedic surgery (n=6). Pain interference (Brief Pain Inventory-Pain Interference), pain intensity (Numerical Rating Scale 0 to 10), and chronic postsurgical pain (CPSP; new or worsening pain) were the outcome variables. Multilevel modeling was used to identify whether participant demographics (eg, age, sex, gross motor ability) and psychological factors (parent pain catastrophizing and grit) were associated with pain interference and intensity outcomes.
There was significant variability in pain experience between participants. Moderate to severe pain affected about one-third of participants at all time points, with about one-quarter of participants meeting the criteria for CPSP. Higher parent pain catastrophizing and lower grit were associated with greater pain intensity and interference. Participant age, sex, gross motor ability, and number of prior surgeries were not related to pain outcomes.
Pain, including moderate to severe pain, was experienced by a substantial proportion of children with CP in this sample both before and after orthopaedic surgery. There is initial evidence that psychological factors may be viable predictors of postsurgical pain outcomes, highlighting opportunities for screening and intervention, though further research is needed.
Level II.
许多脑瘫（CP）患儿接受骨科手术。在脑瘫和骨科手术领域，尚未开展前瞻性研究来探索预测疼痛恢复或慢性化的患者或心理因素。在其他儿科临床样本的研究中，术前疼痛、焦虑和灾难化思维被证明可预测疼痛结果。本探索性研究的目的是：（a）纵向量化CP患儿骨科手术前后的疼痛情况；（b）确定与术后疼痛强度和干扰相关的术前因素。
36名儿童（平均年龄 = 12岁，范围 = 4至17岁）的家长在术前1周以及脊柱融合术（n = 10）、多级下肢手术（n = 20）或其他骨科手术（n = 6）后的1、3、6和12个月完成在线调查。疼痛干扰（简明疼痛问卷 - 疼痛干扰）、疼痛强度（数字评分量表0至10）和慢性术后疼痛（CPSP；新出现或加重的疼痛）为结局变量。采用多级模型来确定参与者的人口统计学特征（如年龄、性别、粗大运动能力）和心理因素（家长疼痛灾难化思维和毅力）是否与疼痛干扰和强度结局相关。
参与者之间的疼痛体验存在显著差异。在所有时间点，中度至重度疼痛影响了约三分之一的参与者，约四分之一的参与者符合CPSP标准。家长更高的疼痛灾难化思维和更低的毅力与更大的疼痛强度和干扰相关。参与者的年龄、性别、粗大运动能力和既往手术次数与疼痛结局无关。
在这个样本中，相当一部分CP患儿在骨科手术前后都经历了疼痛，包括中度至重度疼痛。有初步证据表明心理因素可能是术后疼痛结局的可行预测指标，这凸显了筛查和干预的机会，不过仍需进一步研究。
二级
