Examining the prevalence of persistent postsurgical pain in pediatric spinal fusion surgery patients: a biopsychosocial approach

Thesis (M.A.)--Boston UniversityObjective: Despite extensive literature on chronic pain in surgical and nonsurgical adult patient populations and in the pediatric nonsurgical patient population, the acute to chronic postsurgical pain transition in children has been a largely neglected area of research. The purpose of this study was to examine the prevalence of persistent postsurgical pain in patients with adolescent idiopathic scoliosis who undergo spinal fusion surgery and to explore baseline differences between patients in varying longitudinal pain trajectories. Methods: The Scoliosis Research Society Questionnaire-30, which includes pain, self- image, mental health, and activity subscales, was administered to 219 patients at a large Northeast children’s hospital preoperatively and at one- and two-years postoperatively through their involvement in the Prospective Pediatric Scoliosis Study. A subset of these patients (n=77) also completed follow-up data at five-years post-surgery. Pain among this sample (in the past six months, in the past month, and at rest) was examined at each of the time points. Longitudinal pain trajectories were identified using the SAS PROC TRAJ procedure, and trajectory groups were compared for baseline differences in age, self-image, and mental health functioning through one-way analysis of variance and post- hoc analyses. Results: Preoperative pain was high in this sample, with 36% of patients prior to surgery reporting pain in the past month. The number of patients reporting pain in the past month postoperatively fell to 13% at one-year post-surgery but increased to 17% and 20% respectively at two- and five-years follow-up. A five-trajectory model emerged with a “no pain” group, a “pain improvement” group, a “short-term pain” group, a “delayed pain” group, and a “high pain” group with significant differences in baseline age (p<.01), self-image (p<.01), and mental health functioning (p<.01) found across groups. Conclusions: The study suggests that pediatric persistent postsurgical pain is potentially a significant health concern. This study also provides preliminary evidence that baseline psychosocial factors may contribute to patients’ longitudinal pain experiences postoperatively. Efforts should be taken to better understand the role that these predictors play in the emergence of persistent postsurgical pain in pediatric surgical patients and to explore how biological factors affect somatosensory phenotypes in this patient population