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Trajectories, Risk Factors, and Impact of Persistent Pain After Major Musculoskeletal Surgery in Adolescents: A Replication Study

Published:December 30, 2021DOI:https://doi.org/10.1016/j.jpain.2021.12.009

      Highlights

      • This study replicates diverging post-surgical pain trajectories among adolescents.
      • A “High and Persistent Pain” trajectory occurred in about 1 in 5 adolescents.
      • High pre-surgical pain and poor sleep were associated with High and Persistent Pain.
      • Post-surgical pain trajectories diverged during the initial 2 weeks at home.
      • Opportunity exists for early detection of those with high and increasing pain.

      ABSTRACT

      Studies have identified high rates of chronic postsurgical pain in adolescents. Characterizing patterns of pain in the transition from acute to chronic following major surgery may pinpoint critical periods of recovery. This observational study modelled pain trajectories over 1-year following surgery to attempt replication of prior work and evaluate baseline psychosocial factors and 12-month health outcomes. Adolescents 10 to 18 years completed electronic daily pain reporting for 7 days and self-reported health outcomes, at 5 assessment timepoints. Group-based trajectory modelling identified two trajectories with similar starting points in-hospital but distinct recovery courses at home. Pain declined steadily in one group across the study period (“Declining Pain”; estimated probability,18.9%), but pain increased after hospital discharge and remained high through 12-months in the other group (“High and Persistent Pain”; estimated probability,81.1%). Pre-surgery pain (Aor = 1.86, P = .001) and sleep quality (Aor = 0.49, P = .029) were associated with the High and Persistent pain trajectory in multivariate regressions. This trajectory was associated with lower total quality of life (B=-9.79, P = .002), physical health (B = -15.93, P < .001), psychosocial health (B = -6.73, P = .06), and greater fatigue (B = -13.61, P = .001). This study replicated prior findings identifying two post-surgical pain trajectories with diverging pain in the first two weeks. Clinical detection of those with increasing pain and early intervention may interrupt persistence of pain.

      Perspective

      This article replicates a prior study identifying distinct post-surgical pain trajectories, Declining Pain and High and Persistent Pain. The High and Persistent pain trajectory is associated with pre-surgery pain, pre-surgery sleep quality, and lower quality of life (total, physical, and psychosocial health as well as fatigue) at 12-month follow-up.

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      References

      1. Baguley T: Serious stats: A guide to advanced statistics for the behavioral sciences. Palgrave Macmillan; 2012.

        • Baiden P
        • Tadeo S
        The association between excessive screen-time behaviors and insufficient sleep among adolescents: findings from the 2017 youth risk behavior surveillance system.
        Psychiatry Res. 2019; 281: 1125-1186
        • Bailey KM
        • Howard JJ
        • El-Hawary R
        • Chorney J
        Pain trajectories following adolescent idiopathic scoliosis correction: analysis of predictors and functional outcomes.
        J Bone Jt Surg. 2021; 6: e20.00122
        • Birnie K
        • Chorney J
        • El-Hawary R
        • Group P
        Child and parent pain catastrophizing and pain from presurgery to 6 weeks postsurgery: examination of cross-sectional and longitudinal actor-partner effects.
        Pain. 2017; 158: 1886-1892
        • Chan K
        • Mangione-Smith R
        • Burwinkle T
        • Rosen M
        • Varni J
        The PedsQL: reliability and validity of the short-form generic core scales and asthma module.
        Med Care. 2005; 43: 256-265
        • Chidambaran V
        • Ding L
        • Moore D
        • Spruance K
        • Cudilo E
        • Pilipenko V
        • Hossain M
        • Sturm P
        • Kashikar-Zuck S
        • Martin L
        • Sadhasivam S
        Predicting the pain continuum after adolescent idiopathic scoliosis surgery: a prospective cohort study.
        Eur J Pain. 2017; 21: 1252-1265
        • Chorpita B
        • Yim L
        • Moffitt C
        • Umemoto L
        • Francis S
        Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale.
        Behav Res Ther. 2000; 38: 835-855
        • Chorpita BF
        • Moffitt CE
        • Gray J
        Psychometric properties of the Revised child anxiety and depression scale in a clinical sample.
        Behav Res Ther. 2005; 43: 309-322
        • Connelly M
        • Fulmer R
        • Prohaska J
        • Al E
        Predictors of postoperative pain trajectories in adolescent idiopathic scoliosis.
        Spine (Phila Pa 1976). 2014; 39: E174-E181
        • Eaton D
        • McKnight-Eily L
        • Lowry R
        • Perry G
        • Presley-Cantrell L
        • Croft J
        Prevalence of insufficient, borderline, and optimal hours of sleep among high school students - United States, 2007.
        J Adolesc Heal. 2010; 46: 399-401
        • Essner B
        • Noel M
        • Myrvik M
        • Palermo TM
        Examination of the factor structure of the adolescent sleep-wake scale (ASWS).
        Behav Sleep Med. 2015; 13: 296-307
        • Goubert L
        • Eccleston C
        • Vervoort T
        • Jordan A
        • Crombez G
        Parental catastrophizing about their child's pain. The parent version of the Pain Catastrophizing Scale (PCS-P): a preliminary validation.
        Pain. 2006; 123: 254-263
        • Haack M
        • Simpson N
        • Sethna N
        • Kaur S
        • Mullington J
        Sleep deficiency and chronic pain: potential underlying mechanisms and clinical implications.
        Neuropsychopharmacology. 2020; 45: 205-216
        • Hansen M
        • Janssen I
        • Schiff A
        • Zee P
        • Dubocovich M
        The impact of school daily schedule on adolescent sleep.
        Pediatrics. 2005; 115: 1555-1561
        • Hilliard M
        • Lawrence J
        • Modi A
        • Anderson A
        • Crume T
        • Dolan L
        • Merchant A
        • Yi-Frazier J
        • Hood K
        • SfDiYS G
        Identification of minimal clinically important difference scores of the PedsQL in children, adolescents, and young adults with type 1 and type 2 diabetes.
        Diabetes Care. 2013; 36: 1891-1897
        • Houle T
        • Miller S
        • Lang J
        • Booth J
        • Curry R
        • Harris L
        • Aschenbrenner C
        • Eisenach J
        Day-to-day experience in resolution of pain after surgery.
        Pain. 2017; 158: 2147-2154
        • Jenni O
        • Achermann P
        • Carskadon M
        Homeostatic sleep regulation in adolescents.
        Sleep. 2005; 28: 1446-1454
        • Jones BL
        • Nagin DS
        A note on a stata plugin for estimating group-based trajectory models.
        Sociol Methods Res. 2013; 42: 608-613
        • Jones BL
        • Nagin DS
        • Roeder K
        A SAS procedure based on mixture models for estimating developmental trajectories.
        Sociol Methods Res. 2001; 29: 374-393
        • Katz J
        Establishment of a new pain catastrophizing baseline after pediatric major surgery?.
        J Pain. 2015; 16: 388
        • LeBourgeois M
        • Giannotti F
        • Cortesi F
        • Wolfson A
        • Harsh J
        The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents.
        Pediatrics. 2005; 115: 257-265
        • Li C
        Little's test of missing completely at random.
        Stata J. 2013; 13: 795-809
        • Little R
        A test of missing completely at random for multivariate data with missing values.
        J Am Stat Assoc. 1988; 83: 1198-1202
        • van der Nest G
        • Lima Passos V
        • Candel MJJM
        • van Breukelen GJP
        An overview of mixture modelling for latent evolutions in longitudinal data: Modelling approaches, fit statistics and software.
        Adv Life Course Res [Internet] Elsevier. 2020; 43100323
        • Ocay DD
        • Li MM
        • Ingelmo P
        • Ouellet JA
        • Page G
        • Ferland CE
        Predicting acute postoperative pain trajectories and long-term outcomes of adolescents after spinal fusion surgery.
        Pain Res Manag Feb. 2020; 249874739
        • Page M
        • Katz J
        • Romero Escobar E
        • Lutzky-Cohen N
        • Curtis K
        • Fuss S
        • Clarke H
        Distinguishing problematic from nonproblematic postsurgical pain: a pain trajectory analysis after total knee arthroplasty.
        Pain. 2015; 156: 460-468
        • Page M
        • Katz J
        • Stinson J
        • Isaac L
        • Martin-Pichora A
        • Campbell F
        Validation of the numerical rating scale for pain intensity and unpleasantness in pediatric acute postoperative pain: sensitivity to change over time.
        J Pain. 2012; 13: 359-369
        • Page M
        • Stinson J
        • Campbell F
        • Issac L
        • Katz J
        Pain-related psychological correlates of pediatric acute post-surgical pain.
        J Pain Res. 2012; 5: 547-558
        • Panepinto J
        • Torres S
        • Bendo C
        • McCavit T
        • Dinu B
        • Sherman-Bien S
        • Bemrich-Stolz C
        • Varni J
        PedsQL Multidimensional Fatigue Scale in sickle cell disease: feasibility, reliability, and validity.
        Pediatr Blood Cancer. 2014; 61: 171-177
        • Paul A H
        • Taylor R
        • Thielke R
        • Payne J
        • Gonzalez N
        • Conde JG
        Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Rabbitts J
        • Palermo TM
        • Lang E
        A conceptual model of biopsychosocial mechanisms of transition from acute to chronic postsurgical pain in children and adolescents.
        J Pain Res. 2020; 13: 3071-3080
        • Rabbitts J
        • Zhou C
        • de la Vega R
        • Al E
        A digital health peri-operative cognitive-behavioral intervention to prevent transition from acute to chronic postsurgical pain in adolescents undergoing spinal fusion (SurgeryPalTM): study protocol for a multisite randomized controlled trial.
        Trials. 2021; 22: 506
        • Rabbitts JA
        • Fisher E
        Postsurgical pain in children: unraveling the interplay between child and parent psychosocial factors.
        Pain. 2017; 158: 1847-1848
        • Rabbitts JA
        • Fisher E
        • Rosenbloom BN
        • Palermo TM
        Prevalence and predictors of chronic postsurgical pain in children: a systematic review and meta-analysis.
        J Pain [Internet] Elsevier Inc. 2017; 18: 605-614
        • Rabbitts JA
        • Groenewald CB
        • Tai G
        • Palermo TM
        Presurgical psychosocial predictors of acute postsurgical pain and quality of life in children undergoing major surgery.
        J Pain. 2015; 16: 226-234
        • Rabbitts JA
        • Groenewald CB
        • Zhou C
        Subacute pain trajectories following major musculoskeletal surgery in adolescents: A pilot study.
        Can J Pain. 2020; 4: 3-12
        • Rabbitts JA
        • Mangione-Smith R
        • Palermo TM
        The impact of pain on health-related quality of life in children after surgery.
        J Pain. 2014; 15: S34
        • Rabbitts JA
        • Palermo TM
        • Zhou C
        • Meyyappan A
        • Chen L
        Psychosocial predictors of acute and chronic pain in adolescents undergoing major musculoskeletal surgery.
        J Pain. 2020; 21: 1236-1246
        • Rabbitts JA
        • Zhou C
        • Groenewald CB
        • Durkin L
        • Palermo TM
        Trajectories of postsurgical pain in children: Risk factors and impact of late pain recovery on long-term health outcomes after major surgery.
        Pain. 2015; 156: 2383-2389
        • Rosenbloom B
        • Page M
        • Isaac L
        • Campbell F
        • Stinson JN
        • Wright JG
        • Katz J
        Pediatric Chronic postsurgical pain and functional disability: a prospective study of risk factors up to one year after major surgery.
        J Pain Res. 2019; 12: 3079-3098
        • van de Schoot R
        • Sijbrandij M
        • Winter SD
        • Depaoli S
        • Vermunt JK
        The GRoLTS-Checklist: guidelines for reporting on latent trajectory studies.
        Struct Equ Model. 2017; 24: 451-467
        • Sieberg C
        • Klain J
        • Wong C
        • Bowen G
        • Simons L
        • Millis M
        Predictors and pain trajectories of chronic postoperative pain following hip preservation surgery.
        J Hip Preserv Surg. 2017; 27: 45-53
        • Sieberg C
        • Simons L
        • Edelstein M
        • Al E
        Pain prevalence and trajectories following pediatric spinal fusion surgery.
        J Pain. 2013; 14
        • Varni J
        • Burwinkle T
        • Seid M
        • Skarr D
        The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity.
        Ambulanc Pediatr. 2003; 3: 329-341
        • Voepel-Lewis T
        • Caird M
        • Tait A
        A high preoperative pain and symptom profile predicts worse pain outcomes for children after spine fusion surgery.
        Anesth Analg. 2017; 124: 1594-1602
        • Williams G
        • Howard R
        • Liossi C
        Persistent post-surgical pain in children and young people: prediction, prevention, and management.
        Pain Rep. 2017; 2