Biopsychosocial predictors of opioid use for pediatric postsurgical pain

阿片类药物用于小儿术后疼痛的生物心理社会预测因素

• 批准号: 10395431
• 负责人: Amanda Leigh Stone
• 金额: $ 13.36万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10395431
• 关键词: 2-arachidonylglycerol; Acute Pain; Address; Adenoidectomy; Adolescence; Adult; Analgesics; Anxiety; Belief; Biological; Biological Factors; Blood; Caring; Child; Childhood; Clinical; Collaborations; Collection; Complex; Data; Dehydration; Development; Emergency department visit; Emotional; Emotions; Endocannabinoids; Frequencies; Gatekeeping; Guidelines; Health Care Costs; Home; Iatrogenesis; Instruction; Interdisciplinary Study; Intervention; Joints; Leadership; Measures; Mentored Patient-Oriented Research Career Development Award; Modeling; Nausea; Only Child; Operative Surgical Procedures; Opioid; Opioid Analgesics; Outcome; Pain; Pain intensity; Pain management; Parent-Child Relations; Parents; Patient Education; Pattern; Pediatric Surgical Procedures; Pharmaceutical Preparations; Postoperative Pain; Postoperative Period; Practice Management; Predisposition; Procedures; Process; Provider; Psychological Factors; Psychosocial Factor; Quality of life; Recording of previous events; Research; Research Personnel; Risk; Self Efficacy; Severities; Standardization; Statistical Models; Subgroup; Surveys; Telephone; Testing; Time; Tissues; Tonsillectomy; Training; Uncertainty; Ventilatory Depression; Youth; aged; anandamide; biopsychosocial; biopsychosocial factor; career development; chronic pain; clinical development; coping; design; diaries; endogenous opioids; experience; follow up assessment; follow-up; hospital readmission; improved; innovation; medication administration; negative affect; novel; opioid disposal; opioid misuse; opioid policy; opioid use; pain outcome; pain relief; parental influence; pediatric patients; predictive modeling; prescription opioid; programs; prospective; psychologic; psychosocial; respiratory; response; screening; side effect; skills; social factors; social influence; therapy development; young adult

Abstract: Opioid analgesics are commonly used to manage children’s postoperative pain. Under-medication of children’s postsurgical pain can have significant consequences including reduced quality of life, respiratory issues, dehydration, and nausea, which can increase health care costs due to emergency department visits, provider phone calls, and readmissions. In contrast, a proportion of parents may over-medicate children’s postsurgical pain, potentially leading to greater respiratory depression and other opioid side effects. Given (a) the potential repercussions of under- or over-medicating postsurgical pain in children, (b) uncertainty regarding level of opioid analgesics needed for optimal postsurgical pain management, and (c) increasing societal focus on the negative consequences of opioid medications, further understanding the patterns and predictors of home opioid use and pain management following surgical procedures in children is necessary to guide development of interventions to enhance appropriate analgesic use for pediatric postsurgical pain. The proposed project is designed to address this gap in understanding by prospectively examining parent and child predictors of the extent of opioid analgesic use following tonsillectomy and adenoidectomy (T&A) procedures in pediatric patients aged 7 to 12 years. Parents and youth will complete preoperative measures regarding opioid medication beliefs, pain-related beliefs and emotional responses, and history of painful experiences and opioid use. At the time of IV placement for surgery, blood will be collected to assess children’s circulating endocannabinoid levels. Following surgery, parents and youth will complete electronic diaries regarding pain, emotions, medication use, and side-effects 3 times a day for 7 days and a 3-month follow-up survey assessing additional opioid use and opioid disposal. The central aims of this proposal are to understand parent and child factors that may predict opioid analgesic use following T&A procedures in order to inform predictive models for opioid-related outcomes following pediatric surgeries more broadly. A key innovation of this project is the examination of joint influences of parent and child factors on postoperative opioid use patterns. We hypothesize that parents and children who tend to catastrophize more about painful experiences, have positive beliefs regarding opioid efficacy, and less negative beliefs regarding opioid side effects will be more likely to use opioid medications and be less likely to dispose of opioid medications. Identifying these parent and child predictors could allow for the development of targeted screening and patient education in order to identify potentially modifiable targets for interventions to improve pediatric postsurgical pain management and reduce opioid-related risks. Further, this project provides critical career development support for a young investigator focused on developing expertise in pediatric acute pain, opioid guidelines and clinical opioid use patterns, advanced statistical modeling skill, leadership skills, and biological mechanisms related to pain and opioid use which will inform an overall program of research focused on improving pain management practices for children.

摘要：阿片类镇痛药通常用于管理儿童术后疼痛。不足 儿童的术后疼痛可能会带来重大后果，包括生活质量，呼吸道 问题，脱水和恶心，可以增加由于急诊室就诊而增加医疗保健费用， 提供者电话和再入院。相比之下，一定比例的父母可能过度服从孩子的 术后疼痛，可能导致更大的呼吸道抑郁和其他阿片类药物副作用。给定（a） 儿童术后疼痛或过度服药的潜在影响，（b）有关的不确定性 最佳术后疼痛管理所需的阿片类镇痛药水平，以及（c）增加社会重点 关于阿片类药物的负面后果，进一步了解 在儿童外科手术程序之后，家庭使用阿片类药物的使用和疼痛管理是必要的 开发干预措施以增强儿科术后疼痛的适当镇痛作用。 拟议的项目旨在通过前瞻性检查父母和子女来解决这一差距 预测扁桃体切除术和腺样切除术（T＆A）程序后使用oid镇痛的程度 儿科患者7至12岁。父母和青年将完成有关阿片类药物的术前措施 药物信念，与疼痛有关的信念和情感反应以及痛苦的经历和阿片类药物的历史 使用。在静脉注射手术时，将收集血液以评估儿童循环 内源性大麻素水平。手术后，父母和青年将完成有关疼痛的电子日记， 情绪，用药和副作用每天3次，持续7天，并进行3个月的随访评估 其他阿片类药物使用和阿片类药物处置。该提议的主要目的是了解父母和孩子 可能预测按照T＆A程序进行阿片类镇痛药的因素，以便为预测模型提供信息 小儿手术后，阿片类药物相关的结果更广泛。该项目的关键创新是 检查父母和儿童因素对术后阿片类药物使用模式的关节影响。我们 假设倾向于灾难性的父母和孩子更多地涉及痛苦的经历，具有积极的态度 关于阿片类药物有效性以及对阿片类药物副作用的负面信念的信念更可能更有可能 使用阿片类药物，不太可能处置阿片类药物。确定这些父母和孩子 预测因素可以允许开发目标筛查和患者教育，以确定 潜在的可修改目标，以改善儿科术后疼痛管理并减少 阿片类药物相关的风险。此外，该项目为年轻调查员提供了关键的职业发展支持 专注于发展小儿急性疼痛，阿片类药物指南和临床阿片类药物使用模式的专业知识， 先进的统计建模技能，领导技能和与疼痛和阿片类药物使用有关的生物学机制 这将为一项整体研究计划提供信息，重点是改善儿童疼痛管理实践。