Chronic Postsurgical Pain in Cerebral Palsy

项目摘要 对于脑卒中患者来说，手术前后疼痛的相关知识存在严重差距。 麻痹（CP），包括慢性术后疼痛（CPSP）的发展; 手术后疼痛）。CPSP是一个特别令人不安的结果;它很难治疗，并可能影响所有人 生活的各个方面，延长阿片类药物的使用，减少手术结果，并可以持续一生。在没有 残疾，CPSP估计发生在13-69%接受骨科手术的患者中，包括脊柱 核聚变CPSP在CP儿童中可能至少如此频繁。患有CP的儿童可能会接受8-22次矫形手术 手术在他们的一生中，但围手术期疼痛很少在文献中记录。的长期目标 我们建议的项目是开发安全有效的策略，以减少CPSP的发生率和严重程度 CP儿童目前的目标是记录围手术期疼痛经验的典型轨迹 在CP和确定重要的预测因素的发展CPSP。我们的核心假设， 在先前对无残疾人的研究中，CP儿童有可靠的可识别轨迹， 围手术期疼痛，以及预测CPSP发展的危险因素。风险因素知识 CP儿童CPSP的治疗将支持未来对CPSP风险患者的治疗，并将 最终支持上级干预措施的开发和提供。将对研究假设进行检验 通过完成以下具体目标：1）记录疼痛和阿片类药物使用之前和之后的典型过程 CP儿童矫形手术后一年; 2）识别特征（例如，CP严重度， 预测CPSP和持续阿片类药物使用的灾难性）;以及3）检查 围手术期疼痛严重程度和功能/活动性结局。为了实现目标，疼痛和阿片类药物的使用将 通过父母和子女（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（例如，焦虑）将在手术前进行评估， 功能测量（例如，步态运动学）将在手术前和手术后一年进行评估。对准 利用生物行为疼痛网络模型，修改的（即，非语言依赖性）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。迄今为止的工作得出结论， 疼痛在患有CP的个体中是普遍的、持久的和使人衰弱的。建议的研究是创新的 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，和（B）将开发一个风险指数，以提供个体患者的CPSP风险百分比。我们 我认为这里的知识转化潜力很大。这一贡献将是重大的，因为它将 使该领域能够识别CPSP风险最大的CP患者， 部署当前的临床围手术期疼痛管理策略，管理已确定的心理社会因素， 促进关于手术和非手术治疗的知情决策。

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.