title: Pain prevalence and trajectories following pediatric spinal fusion surgery.
abstract: Factors contributing to pain following surgery are poorly understood, with previous research largely focused on adults. With approximately 6 million children undergoing surgery each year, there is a need to study pediatric persistent postsurgical pain. The present study includes patients with adolescent idiopathic scoliosis undergoing spinal fusion surgery enrolled in a prospective, multicentered registry examining postsurgical outcomes. The Scoliosis Research Society Questionnaire-Version 30, which includes pain, activity, mental health, and self-image subscales, was administered to 190 patients prior to surgery and at 1 and 2 years postsurgery. A subset (n = 77) completed 5-year postsurgery data. Pain prevalence at each time point and longitudinal trajectories of pain outcomes derived from SAS PROC TRAJ were examined using analyses of variance and post hoc pairwise analyses across groups. Thirty-five percent of patients reported pain in the moderate to severe range presurgery. One year postoperation, 11% reported pain in this range, whereas 15% reported pain at 2 years postsurgery. At 5 years postsurgery, 15% of patients reported pain in the moderate to severe range. Among the 5 empirically derived pain trajectories, there were significant differences on self-image, mental health, and age. Identifying predictors of poor long-term outcomes in children with postsurgical pain may prevent the development of chronic pain into adulthood.
  
  
  CONCLUSIONS
  This investigation explores the prevalence of pediatric pain following surgery, up to 5 years after spinal fusion surgery. Five pain trajectories were identified and were distinguishable on presurgical characteristics of age, mental health, and self-image. This is the largest study to examine longitudinal pediatric pain trajectories after surgery.
authors.affiliation: Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts. Electronic address: christine.sieberg@childrens.harvard.edu.
authors.forename: Christine B
authors.initials: CB
authors.lastname: Sieberg
authors.forename: Laura E
authors.initials: LE
authors.lastname: Simons
authors.forename: Mark R
authors.initials: MR
authors.lastname: Edelstein
authors.forename: Maria R
authors.initials: MR
authors.lastname: DeAngelis
authors.forename: Melissa
authors.initials: M
authors.lastname: Pielech
authors.forename: Navil
authors.initials: N
authors.lastname: Sethna
authors.forename: M Timothy
authors.initials: MT
authors.lastname: Hresko
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010147:Pain Measurement / Q000379:methods* / Q000639:trends; D010149:Postoperative Pain / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012600:Scoliosis / Q000453:epidemiology* / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
keywords: Persistent postsurgical pain; pain prevalence; pediatric chronic pain; spinal fusion surgery; trajectories