Retrospective, matched study of patients with adolescent idiopathic scoliosis (AIS) and patients with cerebral palsy (CP) undergoing (PSF).
To compare pain management, through measurement of the amount of narcotic used and pain scores, for patients with neuromuscular (NM) scoliosis undergoing PSF to a cohort of patients with AIS.
Summary of Background Data
Posterior spinal fusion for children with severe NM scoliosis carries a high risk of complications. Appropriate assessment of pain is crucial; undertreatment of pain leads to anxiety whereas overtreatment can lead to respiratory depression and additional complications.
A series of patients with NM scoliosis was matched for age, gender, and weight with a group of patients with AIS. Data collection included age, curve type and magnitude, and instrumentation type and levels fused. The total opioid used (TOU) was determined by summing all narcotics given during the hospital stay and converting them to morphine equivalent units. The data were then analyzed to determine differences in TOU.
A total of 25 patients with NM scoliosis were included in the study. This group was matched with 25 patients with AIS scoliosis. The TOU for the NM group was 1.2 mg morphine/kg (range, 0.28—4.21 mg morphine/kg) whereas the TOU for the AIS group was 3.52 mg morphine/kg (range, 0.71 — 15.51 mg morphine/kg) (p <.0000001).
In this case-control analysis, patients with AIS undergoing PSF received more than twice the amount of narcotic compared with a matched group of patients with NM scoliosis. These data suggest that NM patients’ pain may be undertreated compared with AIS patients. More study is indicated to investigate pain assessment and pain control in this vulnerable patient population to improve care.
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McKearnan KA, Kieckhefer GM, Engel JM, et al. Pain in children with cerebral palsy: a review. J Neurosci Nurs 2003;36:252–9.
Dzienkowski RC, Smith KK, Dillow KA, Yucha CB. Cerebral palsy: a comprehensive review. Nurse Pract 1996;21:45–59.
Nolan J, Chalkiadis GA, Low J, et al. Anaesthesia and pain management in cerebral palsy. Anaesthesia 2000;55:32–41.
Collignon P, Giusiano B. Validation of a pain evaluation scale for patients with severe cerebral palsy. Eur J Pain 2001;5:433–42.
Russo RN, Miller MD, Hann E, et al. Pain characteristics and their association with quality of life and self-concept in children with hemiplegic cerebral palsy identified from a population register. Clin J Pain 2008;24:335–42.
Russman BS. Cerebral palsy. Curr Treat Options Neurol 2000;2:97–108.
Liptak GS, O’Donnell M, Conaway M, et al. Health status of children with moderate to severe cerebral palsy. Dev Med Child Neurol 2001;43:364–70.
Gajdosik CG, Cicirello N. Secondary conditions of the musculoskeletal system in adolescents and adults with cerebral palsy. Phys Occup Ther Pediatr 2001;21:49–68.
Breau LM, Camfield CS, McGrath PJ, Finley GA. The incidence of pain in children with severe cognitive impairments. Arch Pediatr Adolesc Med 2003;157:1219–26.
Oberlander TF, O’Donnell ME, Montgomery CJ. Pain in children with significant neurological impairment. J Dev Behav Pediatr 1999;20:235–43.
Fanurik D, Koh JL, Harrison RD, et al. Pain assessment in children with cognitive impairment: an exploration of self-report skills. Clin Nurse Res 1998;7:103–19.
Roscigno CI. Addressing spasticity-related pain in children with spastic cerebral palsy. J Neurosci Nurs 2002;34:123–33.
Tervo RC, Symons F, Stout J, et al. Parental report of pain and associated limitations in ambulatory children with cerebral palsy. Arch Phys Med Rehabil 2006;87:928–34.
McGrath PA. Pain in children: nature, assessment, and treatment. New York, NY: Guilford Press; 1990.
Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 1997;23:293–7.
Hemsley B, Balandin S, Togher L. Professionals’ views on the roles and needs of family carers of adults with cerebral palsy and complex communication needs in hospital. J Intellect Dev Disabil 2008;33: 127–36.
Hinno S, Partanen P, Vehviläinen-Julkunen K. Nursing activities, nurse staffing and adverse patient outcomes as perceived by hospital nurses. J Clin Nurs 2012;21:1584–93.
Gelinas C, Johnston C. Pain assessment in the critically ill ventilated adult: validation of the Critical-Care Pain Observation Tool and physiologic indicators. Clin J Pain 2007;23:497–505.
Author disclosures: WS (personal fees from Orthopediatrics, during the conduct of the study); MNF (none); RSC (none); JSJ (none); GRW (none); LSS (none).
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Shrader, M.W., Falk, M.N., Cotugno, R.S. et al. Are We Undermedicating Patients With Neuromuscular Scoliosis After Posterior Spinal Fusion?. Spine Deform 2, 399–403 (2014). https://doi.org/10.1016/j.jspd.2014.04.012
- Cerebral palsy
- Idiopathic scoliosis
- Pain control