title: Predicting the pain continuum after adolescent idiopathic scoliosis surgery: A prospective cohort study.
abstract: Chronic postsurgical pain (CPSP) affects half a million children annually in the United States, with dire socioeconomic consequences, including long-term disability into adulthood. The few studies of CPSP in children are limited by sample size, follow-up duration, non-homogeneity of surgical procedure and factors evaluated.
  
  
  
  In a prospective study of 144 adolescents undergoing a single major surgery (spine fusion), we evaluated demographic, perioperative, surgical and psychosocial factors as predictors of a continuum of postsurgical pain: immediate, pain maintenance at 2-3 months (chronic pain/CP) and persistence of pain a year (persistent pain/PP) after surgery.
  
  
  
  We found an incidence of 37.8% and 41.8% for CP and PP. CP and acute pain were both significant predictors for developing PP (p-value <0.001 and 0.003). Preoperative pain and higher postoperative opioid requirement was significantly associated with CP (p = 0.015, p = 0.002), while Childhood Anxiety Sensitivity Index (p = 0.002) and surgical duration (p = 0.014) predicted PP. The final regression models had reasonable predictive accuracy (c-statistic of 0.73 and 0.83 for CP and PP, respectively). Anxiety scores and catastrophizing for child and parent were found to be significantly correlated (p = 0.005, p = 0.013 respectively). Pain trajectories revealed that 65% of patients who developed PP reported CP and high pain trends; however, 33% of those who developed PP could not be identified using solely pain criteria.
  
  
  
  Persistent postsurgical pain in children is a significant problem. It can be predicted in part by combinations of psychological and clinical variables, which may provide evidence-based measures to prevent development of CPSP in the future.
  
  
  
  In a homogeneous cohort of adolescents undergoing spine fusion, we report a high incidence of persistent postsurgical pain (41.8%) predicted by child anxiety, perioperative pain, and surgical duration. Our results stress timely preventive and therapeutic strategies.
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, USA.|Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA.
authors.forename: V
authors.initials: V
authors.lastname: Chidambaran
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA.|Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, USA.
authors.forename: L
authors.initials: L
authors.lastname: Ding
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, USA.|Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Moore
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, USA.
authors.forename: K
authors.initials: K
authors.lastname: Spruance
authors.affiliation: Pediatric Anesthesia Associates Medical Group Fresno, CA.
authors.forename: E M
authors.initials: EM
authors.lastname: Cudilo
authors.affiliation: Division of Human Genetics, Cincinnati Children's Hospital, USA.
authors.forename: V
authors.initials: V
authors.lastname: Pilipenko
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, USA.
authors.forename: M
authors.initials: M
authors.lastname: Hossain
authors.affiliation: Division of Orthopedic Surgery, Cincinnati Children's Hospital Medical Center, USA.
authors.forename: P
authors.initials: P
authors.lastname: Sturm
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA.
authors.forename: S
authors.initials: S
authors.lastname: Kashikar-Zuck
authors.affiliation: Division of Human Genetics, Cincinnati Children's Hospital, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Martin
authors.affiliation: Department of Anesthesia, Cincinnati Children's Hospital Medical Center, USA.|Department of Pediatrics, Cincinnati Children's Hospital Medical Center, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sadhasivam
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000494:pharmacology / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology*; D058443:Catastrophization / Q000523:psychology*; D002648:Child; D059350:Chronic Pain / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D010149:Postoperative Pain / Q000188:drug therapy*; D010290:Parents; D011446:Prospective Studies; D012600:Scoliosis; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid