Such interventions would have the potential to reduce the prevalence of chronic pain in the population .
Although certain risk factors can identify individuals who are most likely to develop chronic pain , few interventions to prevent chronic pain have been identified .
To facilitate the identification of preventive interventions , an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain .
We present general design considerations for prevention trials in population s that are at relatively high risk for developing chronic pain .
Local Administration of Morphine for Analgesia After Autogenous Anterior or Posterior Iliac Crest Bone Graft Harvest for Spinal Fusion: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study
BACKGROUND : Harvesting of iliac crest graft for spinal fusions is associated with a number of patients reporting residual or chronic pain at the harvest site . Various interventions , including morphine infiltration , have been proposed to minimize the associated pain . METHODS : We performed a prospect i ve , double-blind , r and omized , placebo-controlled study comparing intraoperative infiltration of 5 mg morphine ( treatment ) versus saline ( placebo ) into the iliac crest harvest site for patients undergoing elective spinal surgery . Patients with myelopathy , excessive perioperative opioid use ( 60 mg equivalent morphine/d or more ) , or multilevel ( > 3 levels ) spinal surgery were excluded . Postoperative administration of morphine ( recovery room and patient-controlled analgesia ) was st and ardized . Numerical pain scores specific for the iliac crest site were determined in the immediate postoperative period and at 3 , 6 , and 12 months . RESULTS : Of the 54 patients r and omized , 47 ( 87 % ) were available for review with a minimum of 1-year follow-up . The groups were similar in baseline age , gender , and comorbidities . There was no significant difference between groups in total use of postoperative morphine during the first 24 hours ( P = 0.48 ) . Repeated measures analysis of variance demonstrated no interacting effect of group over time for hip pain at rest ( P = 0.94 ) , hip pain while moving ( P = 0.90 ) , spine pain at rest ( P = 0.99 ) , or spine pain while moving ( P = 0.83 ) . The proportion of patients reporting iliac crest pain at 1-year follow-up was the same between groups ( P = 0.95 ) . CONCLUSIONS : This study has demonstrated that there are no additional benefits for the use of intraoperative infiltration of morphine into the iliac crest harvest site during spinal fusions
Such interventions would have the potential to reduce the prevalence of chronic pain in the population .
Although certain risk factors can identify individuals who are most likely to develop chronic pain , few interventions to prevent chronic pain have been identified .
To facilitate the identification of preventive interventions , an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain .
We present general design considerations for prevention trials in population s that are at relatively high risk for developing chronic pain .