Pain Assessment in Children Undergoing Spine Surgery
Condition: Adolescent Idiopathic Scoliosis; Cerebral Palsy
MeSH terms: Scoliosis; Cerebral Palsy
Study type: Interventional

Summary: 
      Musculoskeletal (MSK) pain is one of the most common types of pain among children and
      adolescents. Recurring episodes of MSK pain conditions have a major impact on the daily
      lives. Children and adolescents with neuromuscular diseases are often unable to report the
      pain the patients experience because of intellectual and/or physical limitations. There is no
      reason to believe that pain is any less frequent or intense in these patients than in
      normally developing patients. Because of the elusive nature of pain in non-verbal children,
      therapeutic decisions are frequently based on vague proxy measures of pain and revert to a
      series of trials and errors. This project creates a unique opportunity to directly
      characterize and compare MSK and surgical pain subjectively in two different patient samples
      (verbal and non-verbal). The ultimate goal is to use this information to offer the highest
      quality of pain control in children with MSK conditions, and more specifically in children
      with limited communication skills unable to communicate their distress associated with the
      surgical procedural.
    

Detailed description: 
      Improvement in the assessment techniques, to enable better pain management in children with
      intellectual and developmental disabilities who are unable to describe the intensity of the
      postsurgical pain, is a cornerstone of our research program. This research project will
      elucidate the regulation of specific markers of global surgical insult (nociception,
      inflammation, stress responses) associated to specific physiological mechanisms related to
      pain in children with and without verbal skills undergoing major orthopaedic surgery. This
      project creates a unique opportunity to directly characterize and compare MSK and surgical
      pain subjectively in the two different patient samples (verbal and non-verbal). As molecular
      events of pathophysiological processes are quantifiable, the investigators will test for
      associations between the expression of front-running pain biomarkers in physiological fluids
      (blood and saliva) and the experience of pain in two patient samples (verbal and non-verbal)
      undergoing major orthopaedic surgery. The identification of biomarkers will provide a deeper
      understanding of a patient's pain perception alongside self-report or observers' report
      subjective measurements. Even with standardization of best practice perioperative anesthetic
      pain management, children undergoing similar surgical procedures experience pain at different
      intensity. Based on preliminary findings, treatment modalities appear to be ineffective in
      one out of five patients. Pain experience variability may originate in the lack of rigor in
      the clinical pain assessment tools. Tools such as numerical rating scales used in the
      perioperative period are not based on objective patient specific pain thresholds. A
      personalized mechanism-based approach may be the key to better identify a patient's
      postsurgical pain outcome and how this assessment could lead to personalized perioperative
      pain management. The ultimate goal is to use this information to offer the highest quality of
      pain control in children with MSK conditions, and more specifically in children with limited
      communication skills unable to communicate their distress associated with the surgical
      procedures.
    

Intervention name(s): Pain assessment for verbal patients; Pain assessment for non-verbal patients
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The pain profile of the patient will be assessed at each time point including biological sample analysis (blood and saliva), quantitative sensory testing (mechanical and thermal), and psychological state via the completion of questionnaires by the patient.; The pain profile of the patient will be assessed at each time point including biological sample analysis (blood and saliva), quantitative sensory testing (mechanical), and psychological state via the completion of questionnaires by the parent of the patient.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Adolescent Idiopathic Scoliosis; Cerebral Palsy; Conditioned Pain Modulation; Chronic Postsurgical Pain; Quantitative Sensory Testing; Pain Management