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Predictors of Postoperative Pain Trajectories in Adolescent Idiopathic Scoliosis

Connelly, Mark PhD*,†; Fulmer, R. Dylan BA*,‡; Prohaska, Jennifer PhD*,§; Anson, Lynn RN-BC*; Dryer, Lisa MSN, RN, CPN*; Thomas, Valorie MSN, RN, CS, PNP*; Ariagno, Jill E. MSN, RN, CPNP*; Price, Nigel MD*,†; Schwend, Richard MD*,†

doi: 10.1097/BRS.0000000000000099

Study Design. Prospective observational study.

Objective. To determine the typical trajectory of pain during the first 6 months after spinal fusion surgery for adolescent idiopathic scoliosis (AIS) and the extent to which certain demographic, medical, and psychological variables modify this trajectory.

Summary of Background Data. Pain after spinal fusion surgery for AIS may not improve predictably with elapsed healing time, and limited data exist on predictors of the course of pain during the initial months after surgery.

Methods. Fifty patients ages 11 to 17 (mean = 14.5, standard deviation = 1.9) with AIS and undergoing posterior spinal fusion surgery comprised the study sample. Pain outcomes were assessed at 4 time points after surgery (2-week, 6-week, 3-month, and 6-month postsurgery). Preoperative predictor variables comprising demographics, baseline Cobb angle, body mass index, baseline pain, and psychological variables (anxiety, negative mood, and confidence in ability to control pain) were assessed 2 weeks before surgery. Perioperative predictor variables comprising pain, pain coping efficacy, negative mood, surgery length, length and lowest level of fusion, and analgesic use were assessed by self-report or record review. Multilevel growth models were used to evaluate hypotheses pertaining to predictors of pain trajectories.

Results. Pain level on average declined predictably with days since surgery (b = −0.14 to −0.19, P < 0.01). For 22% of adolescents, pain was at or above baseline levels through 6 months after surgery. Greater baseline pain and anxiety predicted slower improvement in pain, whereas greater confidence in ability to control pain predicted more rapid declines in pain. None of the demographic or medical variables reliably modified postsurgical pain trajectories.

Conclusion. Although pain typically declines predictably with healing time from spinal fusion surgery for AIS, higher preoperative levels of pain and anxiety may be risk factors for chronic postsurgical pain whereas greater pain coping efficacy may help optimize postsurgical pain outcomes.

Level of Evidence: 3

We evaluated the extent to which certain demographic, medical, and psychological variables predicted the trajectory of pain through 6 months after spinal fusion for adolescent idiopathic scoliosis. Greater baseline pain and anxiety predicted a poorer rate of pain improvement, whereas confidence in ability to manage pain predicted more rapid pain improvement.

*Children's Mercy Hospitals and Clinics, Kansas City, MO

University of Missouri-Kansas City School of Medicine, Kansas City, MO

University of Kansas, Lawrence, KS; and

§University of Kansas Medical Center, Kansas City, MO.

Address correspondence and reprint requests to Mark Connelly, PhD, Integrative Pain Management, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, MO 64108; E-mail:

Acknowledgment date: May 14, 2013. First revision date: September 12, 2013. Second revision date: October 15, 2013. Acceptance date: October 21, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Cross Foundation intramural award funds were received, in part, to support this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins