Pain After Scoliosis Fusion Predictable Says New Study

A new study has been published in the journal Spine, which tracked fifty adolescent idiopathic scoliosis patients following spinal fusion surgery. The paper, titled “Predictors of Postoperative Pain Trajectories in Adolescent Idiopathic Scoliosis(AIS)” found that while pain declined with time, almost a quarter of patients experienced above baseline levels even six months postoperatively. Indeed the greater the pain and anxiety, the slower the improvement. Interestingly, patients with greater confidence in pain control ability saw their levels decline more quickly.

The study was prospective, but only observational and was intended to investigate the first 6 months after spinal fusion surgery for AIS. Notably researchers looked at the extent to which certain demographic, medical, and psychological variables modify the pain trajectory.

So how did the Researchers Perform the Study?

Fifty patients ages 11 to 17 with AIS and undergoing posterior spinal fusion surgery were assessed at 4 time points after surgery (2-week, 6-week, 3-month, and 6-months).

Preoperative predictor variables were assessed two weeks before surgery. These included demographics, baseline Cobb angle(a measure of degree of curvature), body mass index, baseline pain, and psychological variables (anxiety, negative mood, and confidence in ability to control pain).

Other variables were assessed by self-report or record review in the peri-operative period. Measures included pain, ability to cope with it, negative mood, surgery length, length and lowest level of fusion, and analgesic use. These factors were then used statistically to evaluate hypotheses pertaining to predictors of pain trajectories.

Pain Extended by Anxiety

The results showed pain level on average declining predictably with days since surgery. However, for 22% of adolescents, it was at or above baseline levels through 6 months after surgery. Greater perioperative baseline pain and anxiety, as recorded by the patients, were good predictors of slower improvement, whereas greater confidence in ability to control it predicted more rapid declines in expressed levels.

Interestingly, none of the demographic or medical variables reliably modified post-surgical pain trajectories.

So, in conclusion, the higher your pain level and anxiety at the time of surgery, the greater the likelihood of chronic postsurgical pain. Having said that, pain typically declines predictably with healing time from spinal fusion surgery for AIS. Patients with a greater ability to cope with pain seem to suffer less of it.

Study abstract here.

Ref: 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*,†

Spine 01 February 2014 – Volume 39 – Issue 3 – p E174–E181

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