Preoperative Patient Education and Smaller Prescription Quantity Reduce Opioid Use After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: Results of a Prospective Study

Yang, Daniel C. H.; Jha, Sahil; Swallow, Jennylee; Caird, Michelle S.; Lopyan, Alexander; Stepanovich, Matthew; Whyte, Noelle; Li, Ying

doi:10.1097/bpo.0000000000002215

Cited by 4 publications

(1 citation statement)

References 17 publications

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“…For example, parent catastrophic thinking about their child's pain (6,14), and parent anxiety sensitivity (15) have been shown to be involved in the development of CPSP. Importantly, preoperative expectation management has been found to influence postoperative pain outcomes (i.e., pain control, opioid use) (22,23). Other currently non-modifiable risk factors for chronic pain include sex, genetics, and epigenetics (24, 25).…”

Section: Risk Factors For the Development Of Chronic Pain In Childrenmentioning

confidence: 99%

Development and expansion of a pediatric transitional pain service to prevent complex chronic pain

Isaac,

Rosenbloom,

Tyrrell

et al. 2023

Front. Pain Res.

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The prevention of chronic pain is a key priority in North America and around the world. A novel pediatric Transitional Pain Service (pTPS) at the Hospital for Sick Children was established to address four main areas of need, which the authors will describe in more detail: (1) provide comprehensive multi-modal pain management and prevention techniques to children at-risk for the development of chronic pain, (2) provide opioid stewardship for children at-risk for chronic pain and their families at home after discharge, (3) facilitate continuity of pain care for children across transitions between inpatient and outpatient care settings, and (4) support caregivers to manage their child's pain at home. The pTPS works with healthcare providers, patients, and their families to address these areas of need and improve quality of life. Furthermore the service fills the gap between inpatient acute pain services and outpatient chronic pain services (accessible only once pain has persisted for >3 months). In pediatric patients who experience pain in hospital and who have been prescribed opioids, discharge to home or rehabilitation may represent a vulnerable time in which pain may persist and during which analgesic requirements may change. This offers an important opportunity to address and prevent the development of chronic pain, and to monitor opioids while ensuring alternative pain therapy is available. The authors will outline risk factors for persistent postsurgical pain, the development and implementation of a pTPS, present initial clinical outcomes andsuggest areas for future research in this evolving area of care.

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Section: Risk Factors For the Development Of Chronic Pain In Childrenmentioning

confidence: 99%

Development and expansion of a pediatric transitional pain service to prevent complex chronic pain

Isaac,

Rosenbloom,

Tyrrell

et al. 2023

Front. Pain Res.

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Postoperative Opioid Prescription Practices at Discharge for Pediatric Orthopedic Patients: A Systematic Review

Park,

Balachandran,

Sacks

et al. 2024

Journal of the Pediatric Orthopaedic Society of North America

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Is Opioid Consumption Impacted by Study Participation? Maintenance of Fewer Opioid Refills With Reduced Prescription Quantity After Posterior Spinal Fusion in Adolescents With Idiopathic Scoliosis

Gong,

Yang,

Caird

et al. 2024

Journal of Pediatric Orthopaedics

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Background: Opioid overprescribing can lead to nonmedical opioid use. In a previous prospective study (STUDY), we showed that a standardized protocol involving preoperative education and reduced opioid prescription quantity decreased opioid use in idiopathic scoliosis patients following posterior spinal fusion (PSF). A potential limitation was the Hawthorne effect, where participant behavior changes due to observation. At STUDY conclusion, we continued the reduced opioid prescriptions but discontinued the formal preoperative education. This retrospective study (post-STUDY) assessed if opioid refill requests increased outside of a study setting. Methods: Post-STUDY included patients aged 10 to 17 years who underwent PSF for idiopathic scoliosis between January 2022 and December 2023 and were discharged with a prescription of ≤30 oxycodone doses. Patients were excluded if they had previous spine surgery or were discharged with an opioid other than oxycodone. Demographics, perioperative variables, and opioid refill requests were compared with the data from STUDY, in which patients were aware their opioid use would be tracked. Patient-reported outcomes were collected via Scoliosis Research Society-22r (SRS-22r) surveys. Results: The post-STUDY cohort included 67 patients (69% female). The average age at the time of PSF was 13.9 years (range, 11 to 17 y). The mean number of levels fused was slightly higher (10.9 vs. 10.0, P=0.04), and intraoperative estimated blood loss was lower (211 vs. 303 mL, P<0.01) compared with the STUDY cohort. Demographics, preoperative major curve magnitude, surgery duration, and length of hospital stay were similar. The percentage of patients who requested and received opioid refills between the post-STUDY and STUDY cohorts was also similar [6/67 (9%) vs. 3/49 (6%), P=0.30]. SRS-22r showed improvements in self-image, satisfaction, and mean total score from preoperative to postoperative. Conclusions: Reduced opioid prescriptions did not result in increased opioid refill requests in adolescents undergoing PSF for idiopathic scoliosis outside of a study setting. While formal preoperative discussions about postoperative pain control are important, other factors likely influence opioid use. Further research should explore characteristics that predispose patients to require higher amounts of postoperative opioids. Level of Evidence: Level III—therapeutic.

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Preoperative Patient Education and Smaller Prescription Quantity Reduce Opioid Use After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: Results of a Prospective Study

Cited by 4 publications

References 17 publications

Development and expansion of a pediatric transitional pain service to prevent complex chronic pain

Development and expansion of a pediatric transitional pain service to prevent complex chronic pain

Postoperative Opioid Prescription Practices at Discharge for Pediatric Orthopedic Patients: A Systematic Review

Is Opioid Consumption Impacted by Study Participation? Maintenance of Fewer Opioid Refills With Reduced Prescription Quantity After Posterior Spinal Fusion in Adolescents With Idiopathic Scoliosis

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