Chronic Postsurgical Pain in Cerebral Palsy - 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.
