Prevalence and predictors of opioid misuse after adolescent spinal fusion surgery

接受脊柱融合手术的青少年经历严重的急性术后疼痛，并依赖阿片类药物缓解疼痛。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，使这些青年在手术后发生慢性术后疼痛以及持续使用阿片类药物的风险增加。 最近的数据表明，5-7%的青少年在手术后处方阿片类药物，随后持续使用阿片类药物。然而，在了解青少年手术后阿片类药物处方后阿片类药物滥用及其相关风险因素的患病率方面存在差距。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的疼痛。本研究将在一项随机对照试验中探索阿片类药物滥用，该试验是一项大型的、特征良好的、以前未接受过阿片类药物治疗的青少年样本，该试验旨在测试认知行为干预以减少术后疼痛。本研究的目的是前瞻性收集数据，以描述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风险因素。 接受脊柱融合手术的12-18岁青少年将报告基线焦虑，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，青少年将在出院后14天内报告阿片类药物的每日使用情况，并在术后6个月报告阿片类药物滥用情况。该补充奖项的目的是：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; 2）确定术前风险因素，以及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。这项研究将确定患病率和风险因素，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，以减少有问题的阿片类药物行为和由此产生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.