A cluster of high psychological and somatic symptoms in children with idiopathic scoliosis predicts persistent pain and analgesic use 1 year after spine fusion

• Published in: Pediatric anesthesia 2018-10, Vol.28 (10), p.873-880
• Main Authors: Voepel‐Lewis, Terri, Caird, Michelle S., Tait, Alan R., Farley, Frances A., Li, Ying, Malviya, Shobha, Hassett, Afton, Weber, Monica, Currier, Emily, Sibour, Trevor, Clauw, Daniel J.
• Format: Article
• Language: English
• Subjects: Adolescent; adolescents; Analgesics; Analgesics - administration & dosage; Child; children; chronic pain; Chronic Pain - drug therapy; Chronic Pain - etiology; Cluster analysis; Female; Humans; Longitudinal Studies; Male; Medically Unexplained Symptoms; musculoskeletal pain; Pain; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; pediatric pain; postoperative pain; Predictive Value of Tests; Prospective Studies; Scoliosis; Scoliosis - diagnosis; Scoliosis - physiopathology; Scoliosis - psychology; Spinal Fusion - adverse effects; Spinal Fusion - methods
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/pan.13467

Summary 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