Predictors of persistent pain in adolescents after scoliosis surgery

Introduction. Adolescent idiopathic scoliosis is one of the most common spinal deformities in children and adolescents. Due to the nature of surgery, spinal fusion increases their risk of persistent postsurgical pain. One year after scoliosis surgery, a significant part of patients (26%) still reported pain, some with neuropathic characteristics.(1)Method. Literature review.Results. Presurgical pain intensity and pain catastrophizing were both predictive of poorer recovery, and pain catastrophizing predicted poorer pain recovery. Psychological flexibility and postsurgical pain acceptance were predictive of more favorable recovery trajectories in postsurgical pain. These are potentially modifiable factors that can be targeted in presurgical interventions.(2) The knowledge of adolescents undergoing the procedure about the course of the postoperative period positively affects the level of pain, but the information from previously operated peers causes a stronger feeling of pain. Emotions occurring in patients affect the intensity of postoperative pain. The level of knowledge of parents affects the intensity of pain in children. The sense of comfort after the procedure has a positive effect.(3) Few publications examine enhanced recovery after scoliosis surgery (ERAS) in children. The idea of the ERAS protocol is to reduce patient stress, prevent the occurrence of postoperative complications, and reduce hospitalisation time and costs. (4) The ERAS protocol included fasting minimization, carbohydrate loading, the avoidance of background morphine infusions, perioperative opioid-sparing protocols, the use of a cooling brace, early physiotherapy, feeding and oral medications, and the early removal of urinary catheters and surgical drains. The study suggests an ERAS protocol after adolescent idiopathic scoliosis surgery is associated with reduced hospital length of stay and improved postoperative care. (5)Conclusion. There are many modifiable factors that contribute to chronic pain. Early preparation and quickly starting therapeutic interventions after surgery are the factors that improve recovery and prevent persistent pain in adolescents.