Psychological Predictors of Pain Outcomes in Children With Cerebral Palsy Undergoing Orthopaedic Surgery.

IF 1.5 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2025-10-01 Epub Date: 2025-05-07 DOI:10.1097/BPO.0000000000003005
Elizabeth R Boyer, Allison G Corlett, Kyle Nickodem, Frank J Symons, Tom F Novacheck, Chantel C Burkitt
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引用次数: 0

Abstract

Background: Many children with cerebral palsy (CP) undergo orthopaedic surgery. Prospective studies exploring patient or psychological factors predictive of pain recovery or chronicity have not been investigated in CP and orthopaedic surgery. In studies with other pediatric clinical samples, preoperative pain, anxiety, and catastrophizing were shown to be predictive of pain outcomes. The purpose of this exploratory study was to (a) quantify pain presence longitudinally before and after orthopaedic surgery in children with CP and (b) identify preoperative factors associated with postoperative pain intensity and interference.

Methods: Parents of 36 children (mean age=12 y, range=4 to 17) completed online surveys at 1 week preoperative, and 1, 3, 6, and 12 months after spinal fusion (n=10), multilevel lower extremity surgery (n=20), or other orthopaedic surgery (n=6). Pain interference (Brief Pain Inventory-Pain Interference), pain intensity (Numerical Rating Scale 0 to 10), and chronic postsurgical pain (CPSP; new or worsening pain) were the outcome variables. Multilevel modeling was used to identify whether participant demographics (eg, age, sex, gross motor ability) and psychological factors (parent pain catastrophizing and grit) were associated with pain interference and intensity outcomes.

Results: There was significant variability in pain experience between participants. Moderate to severe pain affected about one-third of participants at all time points, with about one-quarter of participants meeting the criteria for CPSP. Higher parent pain catastrophizing and lower grit were associated with greater pain intensity and interference. Participant age, sex, gross motor ability, and number of prior surgeries were not related to pain outcomes.

Conclusions: Pain, including moderate to severe pain, was experienced by a substantial proportion of children with CP in this sample both before and after orthopaedic surgery. There is initial evidence that psychological factors may be viable predictors of postsurgical pain outcomes, highlighting opportunities for screening and intervention, though further research is needed.

Level of evidence: Level II.

接受骨科手术的脑瘫儿童疼痛结局的心理预测因素。
背景:许多脑瘫(CP)患儿接受骨科手术。前瞻性研究探索患者或心理因素预测疼痛恢复或慢性尚未调查在CP和骨科手术。在其他儿科临床样本的研究中,术前疼痛、焦虑和灾难化被证明是疼痛结果的预测因素。本探索性研究的目的是:(a)量化CP患儿骨科手术前后的纵向疼痛,(b)确定与术后疼痛强度和干扰相关的术前因素。方法:36名儿童(平均年龄=12岁,范围=4至17岁)的父母在术前1周、脊柱融合术(n=10)、下肢多节段手术(n=20)或其他骨科手术(n=6)后1、3、6和12个月完成在线调查。疼痛干扰(简短疼痛量表-疼痛干扰)、疼痛强度(数值评定量表0 - 10)和术后慢性疼痛(CPSP;新发疼痛或加重疼痛)是结局变量。采用多水平模型来确定参与者的人口统计数据(如年龄、性别、大运动能力)和心理因素(父母疼痛灾难化和毅力)是否与疼痛干扰和强度结果相关。结果:参与者之间的疼痛体验存在显著差异。在所有时间点,中度至重度疼痛影响了约三分之一的参与者,约四分之一的参与者符合CPSP的标准。更高的亲本疼痛灾难化和更低的沙砾与更大的疼痛强度和干扰相关。参与者的年龄、性别、大肌肉运动能力和之前的手术次数与疼痛结果无关。结论:该样本中相当大比例的CP患儿在骨科手术前后都经历过疼痛,包括中度至重度疼痛。有初步证据表明,心理因素可能是术后疼痛结果的可行预测因素,强调了筛查和干预的机会,尽管需要进一步的研究。证据等级:二级。
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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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