Biopsychosocial predictors of opioid use for pediatric postsurgical pain

摘要：阿片类镇痛剂是治疗儿童术后疼痛的常用药物。用药不足 儿童手术后疼痛可能会产生严重后果，包括生活质量下降、呼吸系统疾病 问题，脱水和恶心，这可能会增加急诊科就诊的医疗费用， 医疗服务提供者的电话，以及重新入院。相比之下，一定比例的父母可能会给孩子过量用药 术后疼痛，可能导致更严重的呼吸抑制和其他阿片类副作用。给予(A) 儿童术后疼痛用药过少或过多的潜在影响，(B)关于 最佳术后疼痛管理所需的阿片类镇痛剂水平，以及(C)增加社会关注度 关于阿片类药物的负面后果，进一步了解阿片类药物的模式和预测因素 儿童手术后家庭阿片类药物的使用和疼痛管理是必要的，以指导 制定干预措施以加强儿童手术后疼痛的适当止痛药的使用。这个 拟议的项目旨在通过前瞻性地检查父母和孩子来解决这种理解上的差距。 扁桃体和腺样体切除术后阿片类止痛剂使用范围的预测因素 7至12岁的儿科患者。家长和青少年将完成有关阿片类药物的术前措施 用药信念、疼痛相关信念和情绪反应，以及痛苦经历和阿片类药物的历史 使用。在静脉置入手术时，将采集血液以评估儿童的循环 内源性大麻素水平。手术后，父母和年轻人将完成关于疼痛的电子日记， 情绪、药物使用和副作用，每天3次，持续7天，并进行为期3个月的跟踪调查评估 额外的阿片类药物使用和阿片类药物处置。这项建议的中心目标是理解父母和孩子 可以预测T&A程序后阿片类止痛药使用的因素，以便为以下方面的预测模型提供信息 更广泛的儿科手术后与阿片类药物相关的结果。该项目的一个关键创新是 亲子因素对术后阿片类药物使用模式联合影响的研究我们 假设父母和孩子更容易对痛苦的经历大惊小怪，他们会有积极的一面 关于阿片类药物疗效的信念，以及关于阿片类药物副作用的较少负面信念将更有可能 使用阿片类药物，不太可能丢弃阿片类药物。标识这些父项和子项 预报器可以允许开展有针对性的筛查和患者教育，以便确定 干预措施的潜在可修改目标，以改善儿科手术后疼痛管理并减少 阿片类药物相关风险。此外，该项目为一名年轻的调查员提供了关键的职业发展支持 重点发展儿科急性疼痛、阿片类药物指南和临床阿片类药物使用模式方面的专门知识， 高级统计建模技能、领导技能以及与疼痛和阿片类药物使用相关的生物机制 这将为专注于改善儿童疼痛管理实践的整体研究计划提供信息。

Abstract: Opioid analgesics are commonly used to manage children’s postoperative pain. Under-medication of children’s postsurgical pain can have significant consequences including reduced quality of life, respiratory issues, dehydration, and nausea, which can increase health care costs due to emergency department visits, provider phone calls, and readmissions. In contrast, a proportion of parents may over-medicate children’s postsurgical pain, potentially leading to greater respiratory depression and other opioid side effects. Given (a) the potential repercussions of under- or over-medicating postsurgical pain in children, (b) uncertainty regarding level of opioid analgesics needed for optimal postsurgical pain management, and (c) increasing societal focus on the negative consequences of opioid medications, further understanding the patterns and predictors of home opioid use and pain management following surgical procedures in children is necessary to guide development of interventions to enhance appropriate analgesic use for pediatric postsurgical pain. The proposed project is designed to address this gap in understanding by prospectively examining parent and child predictors of the extent of opioid analgesic use following tonsillectomy and adenoidectomy (T&A) procedures in pediatric patients aged 7 to 12 years. Parents and youth will complete preoperative measures regarding opioid medication beliefs, pain-related beliefs and emotional responses, and history of painful experiences and opioid use. At the time of IV placement for surgery, blood will be collected to assess children’s circulating endocannabinoid levels. Following surgery, parents and youth will complete electronic diaries regarding pain, emotions, medication use, and side-effects 3 times a day for 7 days and a 3-month follow-up survey assessing additional opioid use and opioid disposal. The central aims of this proposal are to understand parent and child factors that may predict opioid analgesic use following T&A procedures in order to inform predictive models for opioid-related outcomes following pediatric surgeries more broadly. A key innovation of this project is the examination of joint influences of parent and child factors on postoperative opioid use patterns. We hypothesize that parents and children who tend to catastrophize more about painful experiences, have positive beliefs regarding opioid efficacy, and less negative beliefs regarding opioid side effects will be more likely to use opioid medications and be less likely to dispose of opioid medications. Identifying these parent and child predictors could allow for the development of targeted screening and patient education in order to identify potentially modifiable targets for interventions to improve pediatric postsurgical pain management and reduce opioid-related risks. Further, this project provides critical career development support for a young investigator focused on developing expertise in pediatric acute pain, opioid guidelines and clinical opioid use patterns, advanced statistical modeling skill, leadership skills, and biological mechanisms related to pain and opioid use which will inform an overall program of research focused on improving pain management practices for children.