Biopsychosocial predictors of opioid use for pediatric postsurgical pain

阿片类药物用于小儿术后疼痛的生物心理社会预测因素

• 批准号: 10614954
• 负责人: Amanda Leigh Stone
• 金额: $ 13.36万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10614954
• 关键词: 2-arachidonylglycerol; Acute Pain; Address; Adenoidectomy; Adolescence; Adult; Analgesics; Anxiety; Belief; Biological; Biological Factors; Blood; Caring; Child; Childhood; Clinical; Collaborations; Collection; Complex; Data; Dehydration; Development; Electronics; Emergency department visit; Emotional; Emotions; Endocannabinoids; Frequencies; Gatekeeping; Guidelines; Health Care Costs; Home; Iatrogenesis; Instruction; Interdisciplinary Study; Intervention; Joints; Leadership; Measures; Mentored Patient-Oriented Research Career Development Award; Modeling; Nausea; Only Child; Operative Surgical Procedures; Opioid; Opioid Analgesics; Outcome; Pain; Pain intensity; Pain management; Parent-Child Relations; Parents; Patient Education; Pattern; Pediatric Surgical Procedures; Pharmaceutical Preparations; Postoperative Pain; Postoperative Period; Practice Management; Predisposition; Procedures; Process; Provider; Psychological Factors; Psychosocial Factor; Quality of life; Recording of previous events; Research; Research Personnel; Risk; Self Efficacy; Severities; Standardization; Statistical Models; Subgroup; Surveys; Telephone; Testing; Time; Tissues; Tonsillectomy; Training; Uncertainty; Ventilatory Depression; Youth; aged; anandamide; biopsychosocial; biopsychosocial factor; career development; chronic pain; clinical development; coping; design; diaries; endogenous opioids; experience; follow up assessment; follow-up; hospital readmission; improved; innovation; medication administration; negative affect; novel; opioid disposal; opioid misuse; opioid policy; opioid use; pain outcome; pain reduction; pain relief; parental influence; pediatric patients; predictive modeling; prescription opioid; programs; prospective; psychologic; psychosocial; respiratory; response; risk mitigation; screening; side effect; skills; social factors; social influence; therapy development; young adult

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.

翻译后摘要：阿片类镇痛药通常用于管理儿童的术后疼痛。用药不足 儿童的术后疼痛可能会产生严重的后果，包括生活质量下降，呼吸困难， 问题，脱水和恶心，这可能会增加医疗保健费用，由于急诊室访问， 供应商电话和再入院相比之下，一部分父母可能会过度关注孩子的 术后疼痛，可能导致更大的呼吸抑制和其他阿片类药物副作用。给定（a） 儿童术后疼痛用药不足或用药过量的潜在影响，（B）关于以下方面的不确定性 最佳术后疼痛管理所需的阿片类镇痛药水平，以及（c）社会关注度增加 关于阿片类药物的负面影响，进一步了解阿片类药物的模式和预测因素， 有必要指导儿童手术后的家庭阿片类药物使用和疼痛管理 制定干预措施，以加强儿科术后疼痛的适当镇痛剂使用。的 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 扁桃体切除术和腺样体切除术（T&A）后阿片类镇痛药使用程度的预测因素 7至12岁的儿科患者。父母和青少年将完成有关阿片类药物的术前措施 药物信念，疼痛相关信念和情绪反应，以及疼痛经历和阿片类药物史 使用.在IV放置手术时，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3个月的随访调查，评估 阿片类药物使用和阿片类药物处置。该提案的中心目的是了解父母和孩子 可能预测T&A程序后阿片类镇痛药使用的因素，以便为 阿片类药物相关的结果后，儿科手术更广泛。该项目的一个关键创新是 检查父母和儿童因素对术后阿片类药物使用模式的联合影响。我们 假设父母和孩子倾向于对痛苦经历进行灾难化， 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。识别这些父项和子项 预测因子可以允许有针对性的筛查和患者教育的发展，以确定 潜在的可修改的干预目标，以改善儿科术后疼痛管理， 阿片类药物相关风险此外，该项目还为年轻的研究人员提供了重要的职业发展支持 专注于发展儿科急性疼痛，阿片类药物指南和临床阿片类药物使用模式的专业知识， 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学机制 这将为一个专注于改善儿童疼痛管理实践的整体研究计划提供信息。

项目成果

Interventions for Parental Anxiety in Preparation for Pediatric Surgery: A Narrative Review.

• DOI: 10.3390/children8111069
• 发表时间: 2021-11-20
• 期刊: Children (Basel, Switzerland)
• 作者: Santapuram P;Stone AL;Walden RL;Alexander L
• 通讯作者: Alexander L

Leftover Opioid Analgesics and Disposal Following Ambulatory Pediatric Surgeries in the Context of a Restrictive Opioid-Prescribing Policy.

• DOI: 10.1213/ane.0000000000005503
• 发表时间: 2022-01-01
• 期刊: Anesthesia and analgesia
• 影响因子: 5.7
• 作者: Stone AL;Qu'd D;Luckett T;Nelson SD;Quinn EE;Potts AL;Patrick SW;Bruehl S;Franklin AD
• 通讯作者: Franklin AD