Cargando…

Pediatric Chronic Postsurgical Pain And Functional Disability: A Prospective Study Of Risk Factors Up To One Year After Major Surgery

BACKGROUND: Chronic postsurgical pain (CPSP) is a surgical complication associated with increased functional disability, psychological distress, and economic costs. The aims of this paper were to prospectively: (1) examine the incidence of CPSP 6 and 12 months after pediatric major surgery; (2) iden...

Descripción completa

Detalles Bibliográficos
Autores principales: Rosenbloom, Brittany N, Pagé, M Gabrielle, Isaac, Lisa, Campbell, Fiona, Stinson, Jennifer N, Wright, James G, Katz, Joel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858804/
https://www.ncbi.nlm.nih.gov/pubmed/31814752
http://dx.doi.org/10.2147/JPR.S210594
_version_ 1783471032144756736
author Rosenbloom, Brittany N
Pagé, M Gabrielle
Isaac, Lisa
Campbell, Fiona
Stinson, Jennifer N
Wright, James G
Katz, Joel
author_facet Rosenbloom, Brittany N
Pagé, M Gabrielle
Isaac, Lisa
Campbell, Fiona
Stinson, Jennifer N
Wright, James G
Katz, Joel
author_sort Rosenbloom, Brittany N
collection PubMed
description BACKGROUND: Chronic postsurgical pain (CPSP) is a surgical complication associated with increased functional disability, psychological distress, and economic costs. The aims of this paper were to prospectively: (1) examine the incidence of CPSP 6 and 12 months after pediatric major surgery; (2) identify pain intensity and pain unpleasantness trajectories before, and up to 12 months after, surgery; (3) identify pre-operative factors that predict pain trajectory group membership; and (4) identify predictors of 12-month functional disability. METHODS: This study followed 265 children aged 8–17 years at four time points (pre-surgical [T0], in-hospital [T1], 6 [T2] and 12 [T3] months after surgery). Children and parents completed pain and psychological questionnaires. In-hospital physical activity was monitored using actigraphy. RESULTS AND DISCUSSION: The incidence of moderate-to-severe CPSP at 6 and 12 months was 35% (95% CI 29.1% to 41.9%) and 38% (95% CI 32.4% to 45.1%), respectively. Three percent (95% CI 1.17% to 6.23%) and 4% (95% CI 1.45% to 6.55%) of children reported using opioids to manage pain at 6 and 12 months, respectively. Growth mixture modeling revealed a two-class trajectory model with a quadratic slope best fit the data for both pain intensity (Bayesian information criterion [BIC] = 3977.03) and pain unpleasantness (BIC = 3644.45) over the 12 months. Preoperative functional disability and cumulative in-hospital opioid consumption predicted pain intensity trajectories. Preoperative functional disability predicted pain unpleasantness trajectories. Preoperative functional disability (OR: 1.05, 95% CI: 1.01 to 1.09) and pain unpleasantness trajectories (OR: 2.59, 95% CI: 1.05 to 6.37) predicted 12-month moderate-to-severe functional disability. CONCLUSION: Pre-surgical functional disability is the only factor that predicts both 12-month functional disability and the course of pain intensity and pain unpleasantness ratings over the 12-month period.
format Online
Article
Text
id pubmed-6858804
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Dove
record_format MEDLINE/PubMed
spelling pubmed-68588042019-12-06 Pediatric Chronic Postsurgical Pain And Functional Disability: A Prospective Study Of Risk Factors Up To One Year After Major Surgery Rosenbloom, Brittany N Pagé, M Gabrielle Isaac, Lisa Campbell, Fiona Stinson, Jennifer N Wright, James G Katz, Joel J Pain Res Original Research BACKGROUND: Chronic postsurgical pain (CPSP) is a surgical complication associated with increased functional disability, psychological distress, and economic costs. The aims of this paper were to prospectively: (1) examine the incidence of CPSP 6 and 12 months after pediatric major surgery; (2) identify pain intensity and pain unpleasantness trajectories before, and up to 12 months after, surgery; (3) identify pre-operative factors that predict pain trajectory group membership; and (4) identify predictors of 12-month functional disability. METHODS: This study followed 265 children aged 8–17 years at four time points (pre-surgical [T0], in-hospital [T1], 6 [T2] and 12 [T3] months after surgery). Children and parents completed pain and psychological questionnaires. In-hospital physical activity was monitored using actigraphy. RESULTS AND DISCUSSION: The incidence of moderate-to-severe CPSP at 6 and 12 months was 35% (95% CI 29.1% to 41.9%) and 38% (95% CI 32.4% to 45.1%), respectively. Three percent (95% CI 1.17% to 6.23%) and 4% (95% CI 1.45% to 6.55%) of children reported using opioids to manage pain at 6 and 12 months, respectively. Growth mixture modeling revealed a two-class trajectory model with a quadratic slope best fit the data for both pain intensity (Bayesian information criterion [BIC] = 3977.03) and pain unpleasantness (BIC = 3644.45) over the 12 months. Preoperative functional disability and cumulative in-hospital opioid consumption predicted pain intensity trajectories. Preoperative functional disability predicted pain unpleasantness trajectories. Preoperative functional disability (OR: 1.05, 95% CI: 1.01 to 1.09) and pain unpleasantness trajectories (OR: 2.59, 95% CI: 1.05 to 6.37) predicted 12-month moderate-to-severe functional disability. CONCLUSION: Pre-surgical functional disability is the only factor that predicts both 12-month functional disability and the course of pain intensity and pain unpleasantness ratings over the 12-month period. Dove 2019-11-12 /pmc/articles/PMC6858804/ /pubmed/31814752 http://dx.doi.org/10.2147/JPR.S210594 Text en © 2019 Rosenbloom et al. http://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Rosenbloom, Brittany N
Pagé, M Gabrielle
Isaac, Lisa
Campbell, Fiona
Stinson, Jennifer N
Wright, James G
Katz, Joel
Pediatric Chronic Postsurgical Pain And Functional Disability: A Prospective Study Of Risk Factors Up To One Year After Major Surgery
title Pediatric Chronic Postsurgical Pain And Functional Disability: A Prospective Study Of Risk Factors Up To One Year After Major Surgery
title_full Pediatric Chronic Postsurgical Pain And Functional Disability: A Prospective Study Of Risk Factors Up To One Year After Major Surgery
title_fullStr Pediatric Chronic Postsurgical Pain And Functional Disability: A Prospective Study Of Risk Factors Up To One Year After Major Surgery
title_full_unstemmed Pediatric Chronic Postsurgical Pain And Functional Disability: A Prospective Study Of Risk Factors Up To One Year After Major Surgery
title_short Pediatric Chronic Postsurgical Pain And Functional Disability: A Prospective Study Of Risk Factors Up To One Year After Major Surgery
title_sort pediatric chronic postsurgical pain and functional disability: a prospective study of risk factors up to one year after major surgery
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858804/
https://www.ncbi.nlm.nih.gov/pubmed/31814752
http://dx.doi.org/10.2147/JPR.S210594
work_keys_str_mv AT rosenbloombrittanyn pediatricchronicpostsurgicalpainandfunctionaldisabilityaprospectivestudyofriskfactorsuptooneyearaftermajorsurgery
AT pagemgabrielle pediatricchronicpostsurgicalpainandfunctionaldisabilityaprospectivestudyofriskfactorsuptooneyearaftermajorsurgery
AT isaaclisa pediatricchronicpostsurgicalpainandfunctionaldisabilityaprospectivestudyofriskfactorsuptooneyearaftermajorsurgery
AT campbellfiona pediatricchronicpostsurgicalpainandfunctionaldisabilityaprospectivestudyofriskfactorsuptooneyearaftermajorsurgery
AT stinsonjennifern pediatricchronicpostsurgicalpainandfunctionaldisabilityaprospectivestudyofriskfactorsuptooneyearaftermajorsurgery
AT wrightjamesg pediatricchronicpostsurgicalpainandfunctionaldisabilityaprospectivestudyofriskfactorsuptooneyearaftermajorsurgery
AT katzjoel pediatricchronicpostsurgicalpainandfunctionaldisabilityaprospectivestudyofriskfactorsuptooneyearaftermajorsurgery