title: Predictors of postoperative pain trajectories in adolescent idiopathic scoliosis.
abstract: METHODS
  Prospective observational study.
  
  
  OBJECTIVE
  To determine the typical trajectory of pain during the first 6 months after spinal fusion surgery for adolescent idiopathic scoliosis (AIS) and the extent to which certain demographic, medical, and psychological variables modify this trajectory.
  
  
  BACKGROUND
  Pain after spinal fusion surgery for AIS may not improve predictably with elapsed healing time, and limited data exist on predictors of the course of pain during the initial months after surgery.
  
  
  METHODS
  Fifty patients ages 11 to 17 (mean = 14.5, standard deviation = 1.9) with AIS and undergoing posterior spinal fusion surgery comprised the study sample. Pain outcomes were assessed at 4 time points after surgery (2-week, 6-week, 3-month, and 6-month postsurgery). Preoperative predictor variables comprising demographics, baseline Cobb angle, body mass index, baseline pain, and psychological variables (anxiety, negative mood, and confidence in ability to control pain) were assessed 2 weeks before surgery. Perioperative predictor variables comprising pain, pain coping efficacy, negative mood, surgery length, length and lowest level of fusion, and analgesic use were assessed by self-report or record review. Multilevel growth models were used to evaluate hypotheses pertaining to predictors of pain trajectories.
  
  
  RESULTS
  Pain level on average declined predictably with days since surgery (b = -0.14 to -0.19, P < 0.01). For 22% of adolescents, pain was at or above baseline levels through 6 months after surgery. Greater baseline pain and anxiety predicted slower improvement in pain, whereas greater confidence in ability to control pain predicted more rapid declines in pain. None of the demographic or medical variables reliably modified postsurgical pain trajectories.
  
  
  CONCLUSIONS
  Although pain typically declines predictably with healing time from spinal fusion surgery for AIS, higher preoperative levels of pain and anxiety may be risk factors for chronic postsurgical pain whereas greater pain coping efficacy may help optimize postsurgical pain outcomes.
  
  
  METHODS
  3.
authors.affiliation: *Children's Mercy Hospitals and Clinics, Kansas City, MO †University of Missouri-Kansas City School of Medicine, Kansas City, MO ‡University of Kansas, Lawrence, KS; and §University of Kansas Medical Center, Kansas City, MO.
authors.forename: Mark
authors.initials: M
authors.lastname: Connelly
authors.forename: R Dylan
authors.initials: RD
authors.lastname: Fulmer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Prohaska
authors.forename: Lynn
authors.initials: L
authors.lastname: Anson
authors.forename: Lisa
authors.initials: L
authors.lastname: Dryer
authors.forename: Valorie
authors.initials: V
authors.lastname: Thomas
authors.forename: Jill E
authors.initials: JE
authors.lastname: Ariagno
authors.forename: Nigel
authors.initials: N
authors.lastname: Price
authors.forename: Richard
authors.initials: R
authors.lastname: Schwend
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012600:Scoliosis / Q000453:epidemiology* / Q000601:surgery*