Prevalence and predictors of opioid misuse after adolescent spinal fusion surgery

接受脊柱融合手术的青少年会经历严重的急性术后疼痛，并依赖阿片类药物来缓解疼痛。青春期的神经生物学和心理社会变化增加了对慢性疼痛和药物使用的脆弱性，使这些年轻人面临更高的风险，患上手术后慢性疼痛以及手术后持续使用阿片类药物。最近的数据表明，5%-7%的青少年在手术后开出阿片类药物，随后出现持续的阿片类药物使用。然而，在青少年手术后服用阿片类药物处方后，对阿片类药物滥用的流行率及其相关危险因素的了解存在差距。因此，阿片类药物仍然是急性中重度疼痛治疗的基石，通常用于青少年手术后的疼痛治疗。这项研究将在一项随机对照试验中，在一项测试认知行为干预以减少术后疼痛的青少年样本中，探索阿片类药物的滥用。这项研究的目的是前瞻性地收集数据，以确定手术后阿片类药物滥用的特征，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，以及终生滥用处方阿片类药物、止痛偏好和止痛预期。手术后，青年将报告出院后14天内每天阿片类药物的使用情况，并在手术后6个月报告阿片类药物滥用情况。这一补充奖项的目的是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，以及2)确定与手术后短期每日阿片类药物使用和长期阿片类药物滥用有关的术前风险因素以及信念和期望。这项研究将确定患病率和风险因素，为这一领域的未来研究提供信息，并确定围手术期干预的目标，以减少有问题的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.