Background & Aims
Although chronic pain and disability after surgery are more common in women (female sex assigned as birth) compared to men, sex differences in postsurgical pain outcomes and related mechanisms are less understood in adolescence, a crucial period for chronic pain development. This study aimed to compare chronic pain outcomes of female and male youth after spinal fusion, and determine if pain coping (strategies/techniques used to manage and reduce the impact of pain) at 2 months post-surgery explained sex differences in chronic pain outcomes. We hypothesized that 6 months after surgery, females would have a higher rate of chronic postsurgical pain (CPSP), higher pain intensity and interference, and lower physical and emotional functioning compared to males. We also hypothesized that at 2-months, females would endorse more emotion-focused avoidance coping while males would use more distraction strategies; these would mediate sex differences in chronic pain outcomes at 6 months.
Methods
Adolescents undergoing spinal fusion surgery for idiopathic scoliosis, juvenile scoliosis, spondylolisthesis, and kyphosis were recruited from 2 pediatric academic hospitals in the United States. Pain intensity (0-10 NRS), pain interference (0-100 VAS), and physical and emotional functioning (Pediatric Quality of Life Inventory [PedsQL]) were self-reported 6 months post-surgery. CPSP at 6-months was defined as significant pain (NRS?3) related to the surgical area with impaired quality of life (PedsQL<74.9). Pain coping at 2-months was self-reported by the Pain Coping Questionnaire (PCQ), a 39-item measure with 8 subscales. Chi-square and t-tests compared sex differences in 6-month chronic pain outcomes and 2-month pain coping strategies. Age-adjusted mediation analyses with bootstrapping estimated the mediation effects of pain coping on sex differences chronic pain outcomes.
Results
Of the 146 adolescents enrolled (113 females, 32 males; ages 10-18 years, mean 14.7; 57% White, 17% Hispanic), 125 have complete 6-month outcome data (86%). At 6-months, 43 developed CPSP, with a 34% overall incidence. Females had higher rates of CPSP (39% vs 15%, P=0.039), higher pain intensity (3.0 vs 1.8, Cohen’s d=0.66, P=0.004) and pain interference (25.0 vs 13.9, Cohen’s d=0.49, P=0.017), and lower emotional functioning (70.9 vs 84.1, Cohen’s d=-0.57, P=0.010) compared to males. At 2-months after surgery, females endorsed more internalizing/catastrophizing (P=0.008) while males reported more behavioral distraction (P=0.002). Internalizing/catastrophizing at 2 months mediated 21.4% of the sex differences in pain interference (?=2.8, 95% CI 0.2, 6.7, P=0.026) and 34.2% of the sex differences in emotional functioning (?=-5.4, 95% CI -10.1, -1.7, P=0.004) at 6 months. Mediation by behavioral distraction was not significant.
Conclusions
Adolescents assigned female sex at birth had higher rates of CPSP, experienced more severe and debilitating pain, and had lower emotional functioning 6 months after spinal fusion. Pain coping strategies at 2 months after surgery mediated some of these sex differences, with internalizing/catastrophizing coping explaining higher pain disability and lower emotional functioning in females. Findings highlight the importance of understanding sex-specific pain coping mechanisms during the postsurgical acute/subacute period, which may guide the development of targeted interventions to improve long-term postsurgical outcomes and reduce sex disparities in pain during adolescence.
References
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Presenting Author
Rui Li
Poster Authors
Rui Li
PhD
Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, USA
Lead Author
Guillermo Ceniza-Bordallo
Faculty of Nursing, Physiotherapy and Podiatry, University Complutense of Madrid, Madrid, Spain
Lead Author
Tonya M Palermo
PhD
Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington, USA
Lead Author
Jennifer A Rabbitts
MD
Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
Lead Author
Topics
- Epidemiology