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Novac MB, Boldeanu L, Dijmărescu AL, Boldeanu MV, Neamțu SD, Radu L, Manolea MM, Șerbănescu MS, Stoica M, Rotaru LT, Văduva CC. Immune Responses of Healthy Pregnant Women following an Elective Cesarean Section: Effects of Anesthetic Procedures. Diagnostics (Basel) 2024; 14:880. [PMID: 38732295 PMCID: PMC11083323 DOI: 10.3390/diagnostics14090880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
A weakened immune system and more inflammatory cytokines being released are possible effects of the surgical stress that a cesarean section induces. This kind of reaction, in addition to the altered reaction to catecholamines, has the potential to significantly affect the immune system of the mother and the patients' general postoperative course. This prospective study compared the plasma levels of catecholamines and cytokines in healthy pregnant patients having cesarean sections under spinal anesthesia versus general anesthesia. A total of 30 pregnant women undergoing elective cesarean sections were divided into two groups: 15 who received general anesthesia (GA) and 15 who received spinal anesthesia (SA). Blood samples were collected from all subjects before anesthesia induction (pre-OP), 6 h postoperatively (6 h post-OP), and 12 h (12 h post-OP), to measure levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-8, IL-4, IL-10, norepinephrine (NE), and epinephrine (EPI). When we compared the two groups, we discovered that only IL-6 and IL-4 had significantly higher levels pre-OP, whereas all studied cytokines exhibited an increase in the GA versus SA group at 6 and 12 h post-OP. In the case of catecholamines, we discovered that serum levels are positively related with pro-inflammatory or anti-inflammatory cytokines, depending on the time of day and type of anesthetic drugs. Compared to SA, GA has a more consistent effect on the inflammatory response and catecholamine levels. The findings of this study confirm that the type of anesthesia can alter postoperative immunomodulation to various degrees via changes in cytokine and catecholamine production. SA could be a preferable choice for cesarean section because it is an anesthetic method that reduces perioperative stress and allows for less opioid administration, impacting cytokine production with proper immunomodulation.
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Affiliation(s)
- Marius Bogdan Novac
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.B.N.); (M.S.)
| | - Lidia Boldeanu
- Department of Microbiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anda Lorena Dijmărescu
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.M.M.); (C.-C.V.)
| | - Mihail Virgil Boldeanu
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Simona Daniela Neamțu
- Department of Hematology and Immunology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Lucreţiu Radu
- Department of Hygiene, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Maria Magdalena Manolea
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.M.M.); (C.-C.V.)
| | - Mircea-Sebastian Șerbănescu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Maria Stoica
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.B.N.); (M.S.)
| | - Luciana Teodora Rotaru
- Department of Emergency Medicine and First Aid, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Constantin-Cristian Văduva
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.M.M.); (C.-C.V.)
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Murray CB, Bartlett A, Meyyappan A, Palermo TM, Aaron R, Rabbitts J. A pilot feasibility and acceptability study of an internet-delivered psychosocial intervention to reduce postoperative pain in adolescents undergoing spinal fusion. Can J Pain 2021; 6:12-23. [PMID: 35434455 PMCID: PMC9009921 DOI: 10.1080/24740527.2021.2009334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Spinal fusion surgery is a common and painful musculoskeletal surgery performed in the adolescent population. Despite the known risk for developing chronic postsurgical pain, few perioperative psychosocial interventions have been evaluated in this population, and none have been delivered remotely (via the Internet) to improve accessibility. Aims The aim of this single-arm pilot study was to evaluate the feasibility and acceptability of the first Internet-based psychological intervention delivered during the perioperative period to adolescents undergoing major spinal fusion surgery and their parents. Methods Thirteen adolescents (M age = 14.3; 69.2% female) scheduled for spine fusion surgery and their parents were provided access to the online psychosocial intervention program. The program included six lessons delivering cognitive-behavioral therapy skills targeting anxiety, sleep, and acute pain management during the month prior to and the month following surgery. Feasibility indicators included recruitment rate, intervention engagement, and measure completion. Acceptability was assessed via quantitative ratings and qualitative interviews. Results Our recruitment rate was 81.2% of families approached for screening. Among participating adolescent–parent dyads, high levels of engagement were demonstrated (100% completed all six lessons). All participants completed outcome measures. High treatment acceptability was demonstrated via survey ratings and qualitative feedback, with families highlighting numerous strengths of the program as well as areas for improvement. Conclusions These findings suggest that this online psychosocial intervention delivered during the perioperative period is feasible and acceptable to adolescents and their parents. Given favorable feasibility outcomes, an important next step is to evaluate the intervention in a full-scale randomized controlled trial.
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Affiliation(s)
- Caitlin B. Murray
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital, Seattle, WA, USA
| | - Anthea Bartlett
- School of Social and Political Science, The University of Edinburgh, Edinburgh, UK
| | | | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital, Seattle, WA, USA
| | - Rachel Aaron
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Rabbitts
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
- Center for Clinical and Translational Research
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Rabbitts JA, Zhou C, de la Vega R, Aalfs H, Murray CB, Palermo TM. A digital health peri-operative cognitive-behavioral intervention to prevent transition from acute to chronic postsurgical pain in adolescents undergoing spinal fusion (SurgeryPal TM): study protocol for a multisite randomized controlled trial. Trials 2021; 22:506. [PMID: 34330321 PMCID: PMC8325315 DOI: 10.1186/s13063-021-05421-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Spinal fusion surgery is associated with severe acute postsurgical pain and high rates of chronic postsurgical pain in adolescents. Psychological distress, sleep disturbance, and low pain self-efficacy predict higher acute pain and likelihood of developing chronic postsurgical pain. Interventions targeting baseline psychosocial risk factors have potential to interrupt a negative trajectory of continued pain and poor health-related quality of life (HRQL) over time but have not yet been developed and evaluated. This randomized controlled trial will test effectiveness of a digital peri-operative cognitive-behavioral intervention (SurgeryPalTM) vs. education-control delivered to adolescents and their parents to improve acute and chronic pain and health outcomes in adolescents undergoing spine surgery. METHODS Adolescents 12-18 years of age undergoing spinal fusion for idiopathic conditions, and their parent, will be recruited from pediatric centers across the USA, for a target complete sample of 400 dyads. Adolescents will be randomized into 4 study arms using a factorial design to SurgeryPalTM or education control during 2 phases of treatment: (1) pre-operative phase (one-month before surgery) and (2) post-operative phase (1 month after surgery). Acute pain severity and interference (primary acute outcomes) and opioid use will be assessed daily for 14 days following hospital discharge. Chronic pain severity and interference (primary acute outcomes), as well as HRQL, parent and adolescent distress, sleep quality, and opioid use/misuse (secondary outcomes), will be assessed at 3 months and 6 months post-surgery. DISCUSSION Demonstration of effectiveness and understanding optimal timing of perioperative intervention will enable implementation of this scalable psychosocial intervention into perioperative care. Ultimately, the goal is to improve pain outcomes and reduce reliance on opioids in adolescents after spine surgery. TRIAL REGISTRATION NCT04637802 ClinicalTrials.gov. Registered on November 20, 2020.
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Affiliation(s)
- Jennifer A. Rabbitts
- Center for Clinical and Translational Research (CCTR), Seattle Children’s Hospital, 4800 Sand Point Way NE MB.11.500.3, Seattle, WA 98105 USA
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
| | - Chuan Zhou
- Center for Child Health Behavior and Development (CHBD), Seattle Children’s Hospital, 1920 Terry Avenue, Seattle, WA USA
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Rocio de la Vega
- Department of Psychology, University of Málaga, Campus de Teatinos, s/n, 29071 Málaga, Spain
| | - Homer Aalfs
- Center for Child Health Behavior and Development (CHBD), Seattle Children’s Hospital, 1920 Terry Avenue, Seattle, WA USA
| | - Caitlin B. Murray
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
- Center for Child Health Behavior and Development (CHBD), Seattle Children’s Hospital, 1920 Terry Avenue, Seattle, WA USA
| | - Tonya M. Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98195 USA
- Center for Child Health Behavior and Development (CHBD), Seattle Children’s Hospital, 1920 Terry Avenue, Seattle, WA USA
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105 USA
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Rabbitts JA, Palermo TM, Lang EA. 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. [PMID: 33262642 PMCID: PMC7699440 DOI: 10.2147/jpr.s239320] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022] Open
Abstract
Acute and chronic pain are highly prevalent and impactful consequences of surgery across the lifespan, yet a comprehensive conceptual model encompassing biopsychosocial factors underlying acute to chronic pain transition is lacking, particularly in youth. Building on prior chronic postsurgical pain models, we propose a new conceptual model of biopsychosocial mechanisms of transition from acute to chronic postsurgical pain. This review aims to summarize existing research examining key factors underlying acute to chronic postsurgical pain transition in order to guide prevention and intervention efforts aimed at addressing this health issue in children. As pain transitions from acute nociceptive pain to chronic pain, changes in the peripheral and central nervous system contribute to the chronification of pain after surgery. These changes include alterations in sensory pain processing and psychosocial processes (psychological, behavioral, and social components), which promote the development of chronic pain. Patient-related premorbid factors (eg, demographic factors, genetic profile, and medical factors such as premorbid pain) may further modulate these changes. Factors related to acute injury and recovery (eg, surgical and treatment factors), as well as biological response to surgery (eg, epigenetic, inflammatory, and endocrine factors), may also influence this process. Overall, longitudinal studies examining temporal pathways of biopsychosocial processes including both risk and resiliency factors will be essential to identify the mechanisms involved in the transition from acute to chronic pain. Research is also needed to unravel connections between the acute pain experience, opioid exposure, and sensory pain processing during acute to chronic pain transition. Furthermore, future studies should include larger and more diverse samples to more fully explore risk factors in a broader range of pediatric surgeries. The use of conceptual models to guide intervention approaches targeting mechanisms of transition from acute to chronic pain will significantly advance this field and improve outcomes for children and adolescents undergoing surgery.
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Affiliation(s)
- Jennifer A Rabbitts
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children’s Hospital, Seattle, WA, USA
| | - Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
- Center for Child Health, Behavior and Development, Seattle Children’s Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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Gurshawn T, Jackson M, Barr J, Cao-Pham M, Capobianco P, Kuhn D, Motley K, Pope K, Strong J, Kole MJ, Wessell A, Thom SR, Tran QK. Transportation Management Affecting Outcomes of Patients With Spontaneous Intracranial Hemorrhage. Air Med J 2020; 39:189-195. [PMID: 32540110 DOI: 10.1016/j.amj.2019.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/21/2019] [Accepted: 12/05/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Patients with spontaneous intracranial hemorrhage (sICH) have poor outcomes, in part because of blood pressure variability (BPV). Patients with sICH causing elevated intracranial pressure (ICP) are frequently transferred to tertiary centers for neurosurgical interventions. We hypothesized that BPV and care intensity during transport would correlate with outcomes in patients with sICH and elevated ICP. METHODS We analyzed charts from adult sICH patients who were transferred from emergency departments to a quaternary academic center from January 1, 2011, to September 30, 2015, and received external ventricular drainage. Outcomes were in-hospital mortality and the Glasgow Coma Scale on day 5 (HD5GCS). Multivariable and ordinal logistic regressions were used for associations between clinical factors and outcomes. RESULTS We analyzed 154 patients, 103 (67%) had subarachnoid hemorrhage and 51 (33%) intraparenchymal hemorrhage; 38 (25%) died. BPV components were similar between survivors and nonsurvivors and not associated with mortality. Each additional intervention during transport was associated with a 5-fold increase in likelihood to achieve a higher HD5GCS (odds ratio = 5.4; 95% confidence interval, 1.7-16; P = .004). CONCLUSION BPV during transport was not associated with mortality. However, high standard deviation in systolic blood pressure during transport was associated with lower HD5GCS in patients with intraparenchymal hemorrhage. Further studies are needed to confirm our observations.
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Affiliation(s)
| | - Matthew Jackson
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jackson Barr
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Mimi Cao-Pham
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Paul Capobianco
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Diane Kuhn
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | | | - Kanisha Pope
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jonathan Strong
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Matthew J Kole
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD
| | - Aaron Wessell
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD
| | - Stephen R Thom
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
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Predicting Acute Postoperative Pain Trajectories and Long-Term Outcomes of Adolescents after Spinal Fusion Surgery. Pain Res Manag 2020; 2020:9874739. [PMID: 32184913 PMCID: PMC7060857 DOI: 10.1155/2020/9874739] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/12/2019] [Indexed: 01/21/2023]
Abstract
Objectives Acute pain trajectories are associated with long-term outcomes such as persistent pain and functional disability in adults. However, there are limited data on acute postoperative pain trajectories in the pediatric population. The aims of this study were to investigate acute postoperative pain trajectories, their predictors, and their impact on long- term outcomes in adolescents with idiopathic scoliosis. Methods We evaluated the preoperative pain intensity, use of analgesics, psychosocial measures and physical functioning of adolescents scheduled to undergo spinal fusion, and their average 6-hour self-reported pain intensity scores for their entire hospital stay. Six months after surgery, baseline variables were reassessed. We used growth mixture modeling to conduct acute postoperative pain trajectory analysis and to identify predictors of pain trajectories. Generalized linear models were conducted to determine whether acute pain trajectories predict long-term outcomes. Results One hundred and six patients were included in the best-fitted acute pain trajectory model that included four classes that differed in initial pain intensity and rates of change over time. Preoperative pain catastrophizer status and use of analgesics significantly predicted pain trajectory membership. Furthermore, at the 6-month follow-up, patients experiencing moderate-to-severe pain in the acute postoperative period were more likely to report higher levels of pain severity, use pain medication, and miss a greater number of school/work days due to back pain in the last three months. Discussion. Preoperative assessment and analyzing the progression of pain in the acute postoperative period can help identify those at risk of negative long-term outcomes after surgery.
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Brewer R, Blum K, Bowirrat A, Modestino EJ, Baron D, Badgaiyan RD, Moran M, Boyett B, Gold MS. Transmodulation of Dopaminergic Signaling to Mitigate Hypodopminergia and Pharmaceutical Opioid-Induced Hyperalgesia. CURRENT PSYCHOPHARMACOLOGY 2020; 9:164-184. [PMID: 37361136 PMCID: PMC10288629 DOI: 10.2174/2211556009999200628093231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 06/28/2023]
Abstract
Neuroscientists and psychiatrists working in the areas of "pain and addiction" are asked in this perspective article to reconsider the current use of dopaminergic blockade (like chronic opioid agonist therapy), and instead to consider induction of dopamine homeostasis by putative pro-dopamine regulation. Pro-dopamine regulation could help pharmaceutical opioid analgesic agents to mitigate hypodopaminergia-induced hyperalgesia by inducing transmodulation of dopaminergic signaling. An optimistic view is that early predisposition to diagnosis based on genetic testing, (pharmacogenetic/pharmacogenomic monitoring), combined with appropriate urine drug screening, and treatment with pro-dopamine regulators, could conceivably reduce stress, craving, and relapse, enhance well-being and attenuate unwanted hyperalgesia. These concepts require intensive investigation. However, based on the rationale provided herein, there is a good chance that combining opioid analgesics with genetically directed pro-dopamine-regulation using KB220 (supported by 43 clinical studies). This may become a front-line technology with the potential to overcome, in part, the current heightened rates of chronic opioid-induced hyperalgesia and concomitant Reward Deficiency Syndrome (RDS) behaviors. Current research does support the hypothesis that low or hypodopaminergic function in the brain may predispose individuals to low pain tolerance or hyperalgesia.
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Affiliation(s)
- Raymond Brewer
- Department of Nutrigenomics, Genomic Testing Center, Geneus Health, LLC., San Antonio, TX, USA
| | - Kenneth Blum
- Department of Nutrigenomics, Genomic Testing Center, Geneus Health, LLC., San Antonio, TX, USA
- Western University Health Sciences, Pomona, CA., USA
- Division of Neuroscience and Addiction Research, Pathway Healthcare, Birmingham, AL, USA
- Eotvos Loránd University, Institute of Psychology, Budapest, Hungary
- Department of Psychiatry, Wright State University Boonshoft School of Medicine and Dayton VA Medical Center, Dayton, OH, USA
- Department of Psychiatry, University of Vermont, Burlington, VT., USA
| | - Abdalla Bowirrat
- Department of Neuroscience and Genetics, Interdisciplinary Center Herzliya, Israel
| | | | - David Baron
- Western University Health Sciences, Pomona, CA., USA
| | - Rajendra D. Badgaiyan
- Department of Psychiatry, ICHAN School of Medicine, Mount Sinai, New York, NYC. & Department of Psychiatry, South Texas Veteran Health Care System, Audie L. Murphy Memorial VA Hospital, San Antonio, TX, Long School of Medicine, University of Texas Medical Center, San Antonio, TX, USA
| | - Mark Moran
- Department of Nutrigenomics, Genomic Testing Center, Geneus Health, LLC., San Antonio, TX, USA
| | - Brent Boyett
- Division of Neuroscience and Addiction Research, Pathway Healthcare, Birmingham, AL, USA
- Bradford Health Services, Madison, AL., USA
| | - Mark S. Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Mo., USA
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Voepel-Lewis T, Caird MS, Tait AR, Farley FA, Li Y, Malviya S, Hassett A, Weber M, Currier E, de Sibour T, Clauw DJ. A cluster of high psychological and somatic symptoms in children with idiopathic scoliosis predicts persistent pain and analgesic use 1 year after spine fusion. Paediatr Anaesth 2018; 28:873-880. [PMID: 30302887 DOI: 10.1111/pan.13467] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/09/2018] [Accepted: 07/23/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Persistent postoperative pain is a significant problem for many children, particularly for those undergoing major surgery such as posterior spine fusion. More than two-thirds report persistent pain after spine fusion, yet factors that may contribute to poorer outcomes remain poorly understood. AIMS This prospective, longitudinal study examined how psychologic and somatic symptoms cluster together in children aged 10-17 years with idiopathic scoliosis, and tested the hypothesis that a higher psychological and somatic symptom cluster would predict worse pain outcomes 1 year after fusion. METHODS Otherwise healthy children with idiopathic scoliosis completed preoperative surveys measuring recent pain intensity, pain location(s), somatic symptom severity, painDETECT (neuropathic-type pain symptoms), pain interference, fatigue, depression, anxiety, and pain catastrophizing. Pain outcome data were collected during hospitalization, and at 1 year after surgery. RESULTS Ninety-five children completed baseline surveys and a cluster analysis differentiated 28 (30%) with a high symptom profile that included; higher depression, fatigue, pain interference, catastrophizing, and painDETECT scores. High symptom cluster membership independently predicted higher pain interference at 1 year (β 9.92 [95% CI 6.63, 13.2], P < 0.001). Furthermore, children in this high symptom cluster reported significantly higher pain intensity and painDETECT scores, and had a 50% higher probability of continued analgesic use at 1 year compared to those in the Low Symptom Cluster (95% CI 21.3-78.5, P = 0.001). CONCLUSION Findings from this exploratory study suggest a need to comprehensively assess children with scoliosis for preoperative signs and symptoms that may indicate an underlying vulnerability for persistent pain. This, in turn may help guide a comprehensive perioperative treatment strategy to mitigate the potential for long-term pain trajectories.
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Affiliation(s)
- Terri Voepel-Lewis
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Michelle S Caird
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Alan R Tait
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Frances A Farley
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ying Li
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Shobha Malviya
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Afton Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Monica Weber
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Emily Currier
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Trevor de Sibour
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
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Ferland CE, Teles AR, Ingelmo P, Saran N, Marchand S, Ouellet JA. Blood monoamines as potential biomarkers for conditioned pain modulation efficacy: An exploratory study in paediatrics. Eur J Pain 2018; 23:327-340. [DOI: 10.1002/ejp.1307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/04/2018] [Accepted: 08/12/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Catherine E. Ferland
- McGill Scoliosis and Spine Group; Montreal Québec Canada
- Shriners Hospitals for Children-Canada; Montreal Québec Canada
- McGill University Health Centre; Montreal Québec Canada
- Alan Edwards Centre for Research on Pain; Montreal Québec Canada
- Department of Anesthesia; McGill University; Montreal Québec Canada
| | - Alisson R. Teles
- McGill Scoliosis and Spine Group; Montreal Québec Canada
- Shriners Hospitals for Children-Canada; Montreal Québec Canada
- McGill University Health Centre; Montreal Québec Canada
- Alan Edwards Centre for Research on Pain; Montreal Québec Canada
- Division of Pediatric Orthopaedics; McGill University; Montreal Québec Canada
| | - Pablo Ingelmo
- McGill University Health Centre; Montreal Québec Canada
- Alan Edwards Centre for Research on Pain; Montreal Québec Canada
- Department of Anesthesia; McGill University; Montreal Québec Canada
| | - Neil Saran
- McGill Scoliosis and Spine Group; Montreal Québec Canada
- Shriners Hospitals for Children-Canada; Montreal Québec Canada
- McGill University Health Centre; Montreal Québec Canada
- Division of Pediatric Orthopaedics; McGill University; Montreal Québec Canada
| | - Serge Marchand
- Department of Surgery; Université de Sherbrooke; Sherbrooke Québec Canada
| | - Jean A. Ouellet
- McGill Scoliosis and Spine Group; Montreal Québec Canada
- Shriners Hospitals for Children-Canada; Montreal Québec Canada
- McGill University Health Centre; Montreal Québec Canada
- Alan Edwards Centre for Research on Pain; Montreal Québec Canada
- Division of Pediatric Orthopaedics; McGill University; Montreal Québec Canada
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