Prevalence and predictors of opioid misuse after adolescent spinal fusion surgery

青少年接受脊柱融合手术经历严重的急性术后疼痛，依赖阿片类药物缓解疼痛。青春期的神经生物学和社会心理变化增加了对慢性疼痛和药物使用的易感性，使这些青少年患慢性术后疼痛和术后持续使用阿片类药物的风险增加。最近的数据表明，手术后开具阿片类药物处方的5-7%的青少年随后持续使用阿片类药物。然而，对青少年手术后阿片类药物处方后阿片类药物滥用的患病率及其相关危险因素的了解仍存在差距。因此，阿片类药物仍然是急性中重度疼痛管理的基石，通常用于青少年手术后疼痛。本研究将探讨阿片类药物滥用在一个大的，有充分特征的，以前阿片类药物幼稚的青少年样本登记在一个随机对照试验测试认知行为干预减少术后疼痛。本研究的目的是前瞻性地收集数据，以表征术后阿片类药物滥用，并确定术后阿片类药物滥用的危险因素。接受脊柱融合手术的12-18岁青年将报告基线焦虑、抑郁和睡眠，以及处方阿片类药物的终生滥用、疼痛缓解偏好和疼痛缓解预期。手术后，青年将报告出院后14天内每日阿片类药物使用情况，并报告手术后6个月阿片类药物滥用情况。本补充奖励的目的是：1)量化术后阿片类药物使用的风险，包括阿片类药物滥用模式和阿片类药物滥用的原因；2)确定术前危险因素，以及术前与短期每日阿片类药物使用和术后长期阿片类药物滥用相关的信念和期望。本研究将确定患病率和危险因素，为该领域的未来研究提供信息，并确定围手术期干预的目标，以减少问题阿片类药物行为和由此导致的阿片类药物使用障碍。

Adolescents undergoing spinal fusion surgery experience severe acute postoperative pain and rely on opioids for pain relief. Neurobiological and psychosocial changes during adolescence increase vulnerability to chronic pain and to substance use, placing these youth at elevated risk for developing chronic postsurgical pain as well as persistent opioid use following surgery. Recent data suggest that 5-7% of adolescents prescribed an opioid after surgery develop subsequent persistent opioid use. However, there is a gap in understanding prevalence of opioid misuse and its associated risk factors following an opioid prescription after surgery in adolescents. Thus, opioids remain the cornerstone of acute moderate-severe pain management and are commonly prescribed to adolescents for pain following surgery. This study will explore opioid misuse in a large, well characterized, previously opioid-naive sample of adolescents enrolled in a randomized controlled trial testing a cognitive-behavioral intervention for reducing postoperative pain. The objective of this study is to prospectively collect data to characterize opioid misuse following surgery and identify risk factors for postoperative opioid misuse. Youth 12-18 years of age undergoing spinal fusion surgery will report on baseline anxiety, depression, and sleep, as well as lifetime misuse of prescription opioids, pain relief preferences, and pain relief expectancies. After surgery, youth will report on daily opioid use for 14 days following hospital discharge, and report on opioid misuse at 6-months post-surgery. The aims of this supplemental award are to 1) quantify the risk of postoperative opioid use, including opioid misuse patterns and reasons for opioid misuse, and 2) identify pre-surgery risk factors, as well as beliefs, and expectations before surgery associated with short-term daily opioid use and long-term opioid misuse following surgery. This study will identify prevalence and risk factors to inform future research in this area, and identify targets for perioperative intervention to reduce problematic opioid behaviors and resulting opioid use disorders.