Sensory and psychological correlates of postsurgical pain in adolescents with idiopathic scoliosis undergoing spinal fusion surgery: a preliminary analysis
Laplante, Jessica Rae
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OBJECTIVE: Chronic pain, including persistent postsurgical pain, reduces patients' quality of life, mood, and productivity. It presents a significant economic burden to society, yielding an estimated $600 billion annual cost due to health care and lost work productivity. Moderate to severe chronic pain affects 5% of children and adolescents. The current body of knowledge has demonstrated a consensus opinion that psychological factors and sensory factors are correlated with pain in the adult population. However, more research is necessary to determine what role depression and sensory function play in predicting severity of persistent postsurgical pain in children and adolescents. Thus, the present study seeks to explore how, if at all, post-operative pain and functional disability at 1 month postsurgery is correlated with pre-operative depression and sensory profile. METHODS: Eligible candidates were Adolescent Idiopathic Scoliosis (AIS) patients aged 10-17 who have been recommended to undergo spinal fusion surgery at Boston Children's Hospital (BCH). Fifteen participants were included in this study. Prior to surgery, all participants completed the Children's Depression Inventory: Short Form (CDI:S) via REDCap and underwent Quantitative Sensory Testing (QST) on their palmar thenar eminence (non-surgical site) and their lower back (surgical site). Participants' light touch detection thresholds and sharp prick pain threshold scores were determined using von Frey hairs. Participants' pressure-pain sensation threshold scores were determined using a pressure algometer. Warm and cool detection thresholds and hot and cold pain thresholds were measured using a thermode strapped to the skin. At 1 month postsurgery, participants completed the Functional Disability Inventory (FDI) and reported their pain scores, including their current pain, average and worst pain in the last week, average and worst pain in the last month, and average and worst pain in the last six months. Each presurgical variable was compared with each postsurgical variable using Pearson correlations at a significance level of p < 0.05. Additionally, postsurgical FDI scores were compared with postsurgical pain scores using Pearson correlations. RESULTS: Due to the small sample size (N = 15), the results should be considered preliminary. Preoperative CDI:S scores were not found to be correlated with postoperative pain and functional disability at 1 month postsurgery. Several preoperative QST variables were found to be correlated with postsurgical pain at 1 month. Namely, light touch detection threshold on the hand was negatively correlated with current pain (p < 0.05), average pain in the last week (p < 0.05), worst pain in the last week (p < 0.05), average pain in the last month (p < 0.05), and worst pain in the last month (p < 0.05). Warm detection threshold on the hand was negatively correlated with four different post-operative pain measures taken at one month post-surgery: worst pain in the last week (p < 0.05), worst pain in the last month (p < 0.05), average pain in the last six months (p < 0.05), and worst pain in the last six months (p < 0.05). Finally, heat pain threshold on the hand was negatively correlated with worst pain in the last 6 months at 1 month postsurgery (p < 0.05). Furthermore, postsurgical scores on the FDI were positively correlated with current pain at the 1-month post-surgical time point (p < 0.01), average pain in the last week at the 1-month post-surgical time point (p < 0.05), and worst pain in the last week at the 1-month post-surgical time point (p < 0.05). CONCLUSIONS: This study provides preliminary evidence of a correlation between heat sensitivity and poor postsurgical pain outcomes in the AIS population. Contrary to what was expected, hyposensitivity to light touch was correlated with worse pain outcomes. It is unclear why this is the case, and further research on the somatosensory profiles of pain patients is needed to examine this phenomenon. One of the most important findings in the present study is the correlation between post-operative pain and functional disability. The present study contributes to the small but growing body of knowledge surrounding the correlates of pediatric postsurgical pain. The use of QST provides an objective, quantifiable measure of patients' somatosensory profile. Furthermore, the present study contributes to the expansive research base that has shown the detrimental effects of chronic pain, highlighting the correlation between pain and functional disability in the AIS population following spinal fusion surgery.