Chronic Postsurgical Pain in Cerebral Palsy

项目总结 脑部疾病患者在手术前后有关疼痛的知识存在严重差距。 瘫痪(CP)，包括术后慢性疼痛(CPSP；发生或发展的长期疼痛 手术后恶化)。CPSP是一个特别令人不安的结果；它很难治疗，并可能影响到所有人 在生活的方方面面，延长阿片类药物的使用，减少手术结果，并可持续一生。在没有 据估计，在接受整形外科手术的人中，包括脊柱在内的人中有13%-69%会发生CPSP 核聚变。CPSP可能至少在患有CP的儿童中是如此频繁的。患有脑性瘫痪的儿童可能会接受8-22次矫形手术 在他们一生中的手术，然而围手术期疼痛在文献中很少被记录。的长期目标是 我们建议的项目是制定安全和有效的战略，以减少CPSP的发生率和严重性 在脑性瘫痪儿童中。目前的目标是记录围手术期疼痛体验的典型轨迹 并找出CPSP发展的重要预测因素。我们的中心假设，基于 先前对非残疾个体的研究表明，患有脑瘫的儿童具有可靠的可识别轨迹 围术期疼痛，以及预测CPSP发展的危险因素。风险因素知识 对于CP儿童的CPSP，将支持未来向CPSP高危人群提供治疗，并将 最终支持制定和提供更好的干预措施。研究假设将得到检验。 通过完成以下具体目标：1)记录疼痛和阿片类药物使用前和治疗后的典型过程 对患有CP的儿童进行整形外科手术后一年；2)确定特征(例如，CP严重程度， 预测CPSP和持续阿片类药物使用；以及3)检查 围手术期疼痛严重程度和功能/活动结果。为了达到目的，疼痛和阿片类药物的使用将 通过家长和孩子(如果可能)报告进行评估(例如，疼痛位置、强度、干扰、质量) 术后12个月。心理社会因素(如焦虑)将在手术前进行评估， 功能测量(例如，步态运动学)将在手术前和一年后进行评估。在路线上 使用生物行为疼痛网络模型，修改的(即，不依赖于语言的)定量感觉 将在手术前和手术后进行两次测试，以量化疼痛敏感性。到目前为止的工作结论是 疼痛在CP患者中普遍存在，持续时间长，并使人虚弱。建议的研究具有创新性。 因为(A)将记录围手术期疼痛轨迹和预测CPSP和阿片类药物使用的因素 第一次，以及(B)将开发一个风险指数，以提供单个患者对CPSP的风险百分比。我们 期望这里的知识翻译潜力很大。这一贡献将是重大的，因为它将 将现场定位为能够识别CPSP风险最高的CP患者，并提供理由 部署当前临床围手术期疼痛管理策略，管理已确定的心理社会因素，以及 促进关于手术和非手术治疗的明智决策。

PROJECT SUMMARY There is a critical gap in knowledge pertaining to pain before and after surgery for individuals with cerebral palsy (CP), including the development of chronic postsurgical pain (CPSP; long-lasting pain that develops or worsens after surgery). CPSP is an especially troubling outcome; it is difficult to treat and can impact all aspects of life, extend opioid use, diminish surgical outcomes, and can last a lifetime. In children without disability, CPSP is estimated to occur in 13-69% of those undergoing orthopedic procedures, including spinal fusion. CPSP is likely at least this frequent in children with CP. Children with CP may undergo 8-22 orthopedic procedures in their lifetime, yet perioperative pain is rarely documented in the literature. The long-term goal of our proposed project is to develop safe and effective strategies to reduce the incidence and severity of CPSP in children with CP. The current objective is to document the typical trajectory of perioperative pain experience in CP and to identify important predictive factors for the development of CPSP. Our central hypothesis, based on prior research on individuals without disability, is that children with CP have reliably identifiable trajectories of perioperative pain, as well as risk factors that predict the development of CPSP. Knowledge of risk factors for CPSP in children with CP will support future delivery of treatment to those at risk for CPSP and will ultimately bolster the development and provision of superior interventions. The study hypotheses will be tested by completing the following specific aims: 1) document the typical course of pain and opioid use before and for one year after orthopedic surgery in children with CP; 2) identify characteristics (e.g., CP severity, catastrophizing) that predict CPSP and persistent opioid use; and 3) examine the relationship between perioperative pain severity and functional/mobility outcomes. To accomplish the aims, pain and opioid use will be assessed via parent and child (when able) report (e.g., pain location, intensity, interference, quality) prior to and for 12 months after surgery. Psychosocial factors (e.g., anxiety) will be assessed before surgery and functional measures (e.g., gait kinematics) will be assessed before and one year after surgery. In alignment with the Biobehavioral Pain Network model, a modified (i.e., non-language dependent) quantitative sensory test will be conducted before and twice after surgery to quantify pain sensitivity. Work to date concludes that pain is prevalent, long-lasting, and debilitating in individuals with CP. The proposed research is innovative because (a) perioperative pain trajectories and factors predictive of CPSP and opioid use will be documented for the first time, and (b) a risk index will be developed to provide individual patients’ percent risk for CPSP. We expect the knowledge translation potential here to be high. This contribution will be significant because it will position the field with the ability to identify those with CP at greatest risk for CPSP, providing justification to deploy current clinical perioperative pain management strategies, manage identified psychosocial factors, and facilitate informed decision making with respect to surgical and non-surgical treatments.