Spine fusion surgery, performed to correct spine curvature resulting from idiopathic scoliosis, is among the most painful procedures a child can undergo. As many as two-thirds of children report persistent, albeit low-grade pain one year or more after the procedure, and the same proportion of adults who underwent spine fusion surgery as children report ongoing pain.
A team of Michigan Medicine pediatric specialists in orthopaedic surgery, anesthesiology and pain management is collaborating to better understand and address this and other types of pediatric pain. Their research partnership leverages their different perspectives to develop better strategies to not only forecast pediatric post-operative pain, but to interrupt the cycle of suffering and chemical dependency ignited when pain persists into adulthood.
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Their most recent study, led by anesthesiology researcher Terri Voepel-Lewis, Ph.D., R.N., and pediatric orthopaedic surgeon Michelle Caird, M.D., focused on whether a child's history of pain prior to spine fusion surgery could help predict the degree of post-operative pain he or she might experience.
"Clinical practice has shown us that not all children experience the same level of pain after spine fusion surgery," says Voepel-Lewis. "We wondered if we could identify which children face the greatest risk of persistent pain."
The team's prospective, longitudinal study focused on 95 otherwise healthy children with idiopathic scoliosis age 10-17. A validated survey tool was completed by the children in the hospital prior to surgery, and again one year after, to assess a number of symptoms associated with pain.
Clinical practice has shown us that not all children experience the same level of pain after spine fusion surgery. We wondered if we could identify which children face the greatest risk of persistent pain.Terri Voepel-Lewis, Ph.D., R.N.
Different kids, different pain
"The survey covered much more than back pain," explains Voepel-Lewis. "We tried to screen for multiple psychosomatic – mind and body – symptoms related to pain, including depression, fatigue, sleep problems, and pain in other places in the body." The survey also collected data on how much pain interfered with everyday activities, and whether the child was preoccupied, anxious or worried about pain, called pain catastrophizing.
Also included were a series of questions to help children describe the location and severity of their pain. Does it feel like electrical current or bee stings? Does it come and go? Does it stay in one place, or spread?
Based on responses to the pre-operative survey, children were grouped based on the cluster of pain and related symptoms reported.
Twenty-eight of the 95 children surveyed (30 percent) were found to have a high cluster of symptoms pre-operatively. As hypothesized, one year after spine fusion surgery, the higher symptom cluster group suffered more pain. They reported more and more troublesome neuropathic pain symptoms, higher pain intensity and higher pain interference. They were also 50 percent more likely to continue to use analgesic medications at one year when compared with children in the low symptom cluster group.
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Personalizing pain management
"This is the first time we've validated a connection between a scoliosis patient's vulnerability to pain and the persistent pain experienced after spinal fusion surgery," says Caird. "It confirms the need for more individualized pre-operative, interoperative and post-operative pain management strategies."
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Patients identified as the most sensitive to pain might be candidates for tailored interventions to help them get ready for surgery.
"While there is a role for pain medications like analgesics," says Voepel-Lewis, "clearly a one-size-fits-all approach isn't enough for some patients."