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.

Grant Number: 4R01HD108406-04
NIH Institute/Center: NIH
Principal Investigator: Chantel Burkitt