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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT04244760
Other study ID # A08M7114B
Secondary ID
Status Completed
Phase N/A
First received
Last updated
Start date January 2015
Est. completion date March 2022

Study information

Verified date May 2022
Source Shriners Hospitals for Children
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

Musculoskeletal (MSK) pain is one of the most common types of pain among children and adolescents. Recurring episodes of MSK pain conditions have a major impact on the daily lives. Children and adolescents with neuromuscular diseases are often unable to report the pain the patients experience because of intellectual and/or physical limitations. There is no reason to believe that pain is any less frequent or intense in these patients than in normally developing patients. Because of the elusive nature of pain in non-verbal children, therapeutic decisions are frequently based on vague proxy measures of pain and revert to a series of trials and errors. This project creates a unique opportunity to directly characterize and compare MSK and surgical pain subjectively in two different patient samples (verbal and non-verbal). The ultimate goal is to use this information to offer the highest quality of pain control in children with MSK conditions, and more specifically in children with limited communication skills unable to communicate their distress associated with the surgical procedural.


Description:

Improvement in the assessment techniques, to enable better pain management in children with intellectual and developmental disabilities who are unable to describe the intensity of the postsurgical pain, is a cornerstone of our research program. This research project will elucidate the regulation of specific markers of global surgical insult (nociception, inflammation, stress responses) associated to specific physiological mechanisms related to pain in children with and without verbal skills undergoing major orthopaedic surgery. This project creates a unique opportunity to directly characterize and compare MSK and surgical pain subjectively in the two different patient samples (verbal and non-verbal). As molecular events of pathophysiological processes are quantifiable, the investigators will test for associations between the expression of front-running pain biomarkers in physiological fluids (blood and saliva) and the experience of pain in two patient samples (verbal and non-verbal) undergoing major orthopaedic surgery. The identification of biomarkers will provide a deeper understanding of a patient's pain perception alongside self-report or observers' report subjective measurements. Even with standardization of best practice perioperative anesthetic pain management, children undergoing similar surgical procedures experience pain at different intensity. Based on preliminary findings, treatment modalities appear to be ineffective in one out of five patients. Pain experience variability may originate in the lack of rigor in the clinical pain assessment tools. Tools such as numerical rating scales used in the perioperative period are not based on objective patient specific pain thresholds. A personalized mechanism-based approach may be the key to better identify a patient's postsurgical pain outcome and how this assessment could lead to personalized perioperative pain management. The ultimate goal is to use this information to offer the highest quality of pain control in children with MSK conditions, and more specifically in children with limited communication skills unable to communicate their distress associated with the surgical procedures.


Recruitment information / eligibility

Status Completed
Enrollment 240
Est. completion date March 2022
Est. primary completion date January 2022
Accepts healthy volunteers No
Gender All
Age group 10 Years to 18 Years
Eligibility Inclusion Criteria: - Aged between 10 and 21 years old - Scheduled to undergo posterior or anterior spinal fusion surgery for AIS with instrumentation - Ability to adequately understand and respond to outcome measures - No previous major orthopedic surgery - Female or male - Any ethnic background Exclusion Criteria: - Inability of the child to speak English or French - Diagnosed with developmental delay that would interfere with understanding questions being asked (autism, mental retardation) - Children with major chronic medical conditions (ASA status III or higher)

Study Design


Related Conditions & MeSH terms


Intervention

Behavioral:
Pain assessment for verbal patients
The pain profile of the patient will be assessed at each time point including biological sample analysis (blood and saliva), quantitative sensory testing (mechanical and thermal), and psychological state via the completion of questionnaires by the patient.
Pain assessment for non-verbal patients
The pain profile of the patient will be assessed at each time point including biological sample analysis (blood and saliva), quantitative sensory testing (mechanical), and psychological state via the completion of questionnaires by the parent of the patient.

Locations

Country Name City State
Canada Shriners Hospital for Children-Canada Montréal Quebec

Sponsors (1)

Lead Sponsor Collaborator
Catherine Ferland

Country where clinical trial is conducted

Canada, 

Outcome

Type Measure Description Time frame Safety issue
Primary Pain intensity as assessed by the The Faces Pain Scale -Revised (0-10 scale, with higher score indicating more pain) in verbal patients Baseline
Primary Pain intensity as assessed by the The Faces Pain Scale -Revised (0-10 scale, with higher score indicating more pain) in verbal patients Postoperative day 1
Primary Pain intensity as assessed by the The Faces Pain Scale -Revised (0-10 scale, with higher score indicating more pain) in verbal patients Postoperative day 2
Primary Pain intensity as assessed by the The Faces Pain Scale -Revised (0-10 scale, with higher score indicating more pain) in verbal patients Postoperative day 5
Primary Pain intensity as assessed by the The Faces Pain Scale -Revised (0-10 scale, with higher score indicating more pain) in verbal patients 6 weeks postoperative
Primary Pain intensity as assessed by the The Faces Pain Scale -Revised (0-10 scale, with higher score indicating more pain) in verbal patients 6 months postoperative
Primary Pain intensity as assessed by the The Faces Pain Scale -Revised (0-10 scale, with higher score indicating more pain) in verbal patients 1 year postoperative
Primary Pain intensity as assessed by the The Faces Pain Scale -Revised (0-10 scale, with higher score indicating more pain) in verbal patients 2 years postoperative
Primary Pain intensity as assessed by the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R), and its post-operative version in non-verbal patients, with higher score indicating more pain Baseline
Primary Pain intensity as assessed by the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R), and its post-operative version in non-verbal patients, with higher score indicating more pain Postoperative day 1
Primary Pain intensity as assessed by the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R), and its post-operative version in non-verbal patients, with higher score indicating more pain Postoperative day 2
Primary Pain intensity as assessed by the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R), and its post-operative version in non-verbal patients, with higher score indicating more pain Postoperative day 5
Primary Pain intensity as assessed by the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R), and its post-operative version in non-verbal patients, with higher score indicating more pain 6 weeks postoperative
Primary Pain intensity as assessed by the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R), and its post-operative version in non-verbal patients, with higher score indicating more pain 6 months postoperative
Primary Pain intensity as assessed by the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R), and its post-operative version in non-verbal patients, with higher score indicating more pain 1 year postoperative
Primary Pain intensity as assessed by the Non-Communicating Children's Pain Checklist-Revised (NCCPC-R), and its post-operative version in non-verbal patients, with higher score indicating more pain 2 years postoperative
Secondary Mechanical detection threshold (grams) as measured with von Frey filaments Baseline
Secondary Pain pressure threshold (Newtons) as measured with an algometer. Baseline
Secondary Conditioned pain modulation (CPM) efficiency, a physiological parameter calculated as the percentage difference between the average pain intensity (0-10) reported during a thermode (heat) test before and after a cold water submersion bath test. Conditioned pain modulation measurement is omitted in the non-verbal patient arm. Baseline
Secondary Mechanical detection threshold (grams) as measured with von Frey filaments Postoperative day 1
Secondary Pain pressure threshold (Newtons) as measured with an algometer. Postoperative day 1
Secondary Mechanical detection threshold (grams) as measured with von Frey filaments Postoperative day 2
Secondary Pain pressure threshold (Newtons) as measured with an algometer. Postoperative day 2
Secondary Mechanical detection threshold (grams) as measured with von Frey filaments Postoperative day 5
Secondary Pain pressure threshold (Newtons) as measured with an algometer. Postoperative day 5
Secondary Conditioned pain modulation (CPM) efficiency, a physiological parameter calculated as the percentage difference between the average pain intensity (0-10) reported during a thermode (heat) test before and after a cold water submersion bath test. Conditioned pain modulation measurement is omitted in the non-verbal patient arm. Postoperative day 5
Secondary Mechanical detection threshold (grams) as measured with von Frey filaments 6 weeks postoperative
Secondary Pain pressure threshold (Newtons) as measured with an algometer. 6 weeks postoperative
Secondary Conditioned pain modulation (CPM) efficiency, a physiological parameter calculated as the percentage difference between the average pain intensity (0-10) reported during a thermode (heat) test before and after a cold water submersion bath test. Conditioned pain modulation measurement is omitted in the non-verbal patient arm. 6 weeks postoperative
Secondary Mechanical detection threshold (grams) as measured with von Frey filaments 6 months postoperative
Secondary Pain pressure threshold (Newtons) as measured with an algometer. 6 months postoperative
Secondary Conditioned pain modulation (CPM) efficiency, a physiological parameter calculated as the percentage difference between the average pain intensity (0-10) reported during a thermode (heat) test before and after a cold water submersion bath test. Conditioned pain modulation measurement is omitted in the non-verbal patient arm. 6 months postoperative
Secondary Mechanical detection threshold (grams) as measured with von Frey filaments 1 year postoperative
Secondary Pain pressure threshold (Newtons) as measured with an algometer. 1 year postoperative
Secondary Conditioned pain modulation (CPM) efficiency, a physiological parameter calculated as the percentage difference between the average pain intensity (0-10) reported during a thermode (heat) test before and after a cold water submersion bath test. Conditioned pain modulation measurement is omitted in the non-verbal patient arm. 1 year postoperative
Secondary Mechanical detection threshold (grams) as measured with von Frey filaments 2 years postoperative
Secondary Pain pressure threshold (Newtons) as measured with an algometer. 2 years postoperative
Secondary Conditioned pain modulation (CPM) efficiency, a physiological parameter calculated as the percentage difference between the average pain intensity (0-10) reported during a thermode (heat) test before and after a cold water submersion bath test. Conditioned pain modulation measurement is omitted in the non-verbal patient arm. 2 years postoperative
Secondary Total Score of the Pain Catastrophizing Scale (0-52). Higher scores indicate higher levels of pain-related anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Baseline
Secondary Total Score of the Pain Catastrophizing Scale (0-52). Higher scores indicate higher levels of pain-related anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Postoperative day 1
Secondary Total Score of the Pain Catastrophizing Scale (0-52). Higher scores indicate higher levels of pain-related anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Postoperative day 2
Secondary Total Score of the Pain Catastrophizing Scale (0-52). Higher scores indicate higher levels of pain-related anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Postoperative day 5
Secondary Total Score of the Pain Catastrophizing Scale (0-52). Higher scores indicate higher levels of pain-related anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 6 weeks postoperative
Secondary Total Score of the Pain Catastrophizing Scale (0-52). Higher scores indicate higher levels of pain-related anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 6 months postoperative
Secondary Total Score of the Pain Catastrophizing Scale (0-52). Higher scores indicate higher levels of pain-related anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 1 year postoperative
Secondary Total Score of the Pain Catastrophizing Scale (0-52). Higher scores indicate higher levels of pain-related anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 2 years postoperative
Secondary Total score (30-150) across to 4 domains of the Scoliosis Research Society Questionnaire-30 (SRS-30) regarding the outcome of the patient's spine surgery (items scored from 1=worst, to 5=best, thus lower scores mean worse outcomes). 4 domains: 1) pain (max. score 30) 2) mental health (max. score 25) 3) function/activity (max. score 35) 4) Self Image/appearance (max. score 45) Baseline
Secondary Total score (30-150) across to 4 domains of the Scoliosis Research Society Questionnaire-30 (SRS-30) regarding the outcome of the patient's spine surgery (items scored from 1=worst, to 5=best, thus lower scores mean worse outcomes). 4 domains: 1) pain (max. score 30) 2) mental health (max. score 25) 3) function/activity (max. score 35) 4) Self Image/appearance (max. score 45) 6 weeks postoperative
Secondary Total score (30-150) across to 4 domains of the Scoliosis Research Society Questionnaire-30 (SRS-30) regarding the outcome of the patient's spine surgery (items scored from 1=worst, to 5=best, thus lower scores mean worse outcomes). 4 domains: 1) pain (max. score 30) 2) mental health (max. score 25) 3) function/activity (max. score 35) 4) Self Image/appearance (max. score 45) 6 months postoperative
Secondary Total score (30-150) across to 4 domains of the Scoliosis Research Society Questionnaire-30 (SRS-30) regarding the outcome of the patient's spine surgery (items scored from 1=worst, to 5=best, thus lower scores mean worse outcomes). 4 domains: 1) pain (max. score 30) 2) mental health (max. score 25) 3) function/activity (max. score 35) 4) Self Image/appearance (max. score 45) 1 year postoperative
Secondary Total score (30-150) across to 4 domains of the Scoliosis Research Society Questionnaire-30 (SRS-30) regarding the outcome of the patient's spine surgery (items scored from 1=worst, to 5=best, thus lower scores mean worse outcomes). 4 domains: 1) pain (max. score 30) 2) mental health (max. score 25) 3) function/activity (max. score 35) 4) Self Image/appearance (max. score 45) 2 years postoperative
Secondary Total Score of the Functional Disability Inquiry (0-60). Higher scores indicate greater activity limitations during the past 2 weeks. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Baseline
Secondary Total Score of the Functional Disability Inquiry (0-60). Higher scores indicate greater activity limitations during the past 2 weeks. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 6 weeks postoperative
Secondary Total Score of the Functional Disability Inquiry (0-60). Higher scores indicate greater activity limitations during the past 2 weeks. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 6 months postoperative
Secondary Total Score of the Functional Disability Inquiry (0-60). Higher scores indicate greater activity limitations during the past 2 weeks. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 1 year postoperative
Secondary Total Score of the Functional Disability Inquiry (0-60). Higher scores indicate greater activity limitations during the past 2 weeks. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 2 years postoperative
Secondary Score of State Anxiety of the State-Trait Anxiety Scale (20-60). Higher scores indicate greater state anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Baseline
Secondary Score of Trait Anxiety of the State-Trait Anxiety Scale (20-60). Higher scores indicate greater trait anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Baseline
Secondary Score of State Anxiety of the State-Trait Anxiety Scale (20-60). Higher scores indicate greater state anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Day of surgery
Secondary Score of Trait Anxiety of the State-Trait Anxiety Scale (20-60). Higher scores indicate greater trait anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Day of surgery
Secondary Score of State Anxiety of the State-Trait Anxiety Scale (20-60). Higher scores indicate greater state anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 6 weeks postoperative
Secondary Score of Trait Anxiety of the State-Trait Anxiety Scale (20-60). Higher scores indicate greater trait anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 6 weeks postoperative
Secondary Score of State Anxiety of the State-Trait Anxiety Scale (20-60). Higher scores indicate greater state anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 6 months postoperative
Secondary Score of Trait Anxiety of the State-Trait Anxiety Scale (20-60). Higher scores indicate greater trait anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 6 months postoperative
Secondary Score of State Anxiety of the State-Trait Anxiety Scale (20-60). Higher scores indicate greater state anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 1 year postoperative
Secondary Score of Trait Anxiety of the State-Trait Anxiety Scale (20-60). Higher scores indicate greater trait anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 1 year postoperative
Secondary Score of State Anxiety of the State-Trait Anxiety Scale (20-60). Higher scores indicate greater state anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 2 years postoperative
Secondary Score of Trait Anxiety of the State-Trait Anxiety Scale (20-60). Higher scores indicate greater trait anxiety. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 2 years postoperative
Secondary Score on Activity Avoidance and Somatic Function of the Tampa Scale for Kinesiophobia (score 17-68). Higher scores indicate greater kinesiophobia. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Baseline
Secondary Score on Activity Avoidance and Somatic Function of the Tampa Scale for Kinesiophobia (score 17-68). Higher scores indicate greater kinesiophobia. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Postoperative day 1
Secondary Score on Activity Avoidance and Somatic Function of the Tampa Scale for Kinesiophobia (score 17-68). Higher scores indicate greater kinesiophobia. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Postoperative day 2
Secondary Score on Activity Avoidance and Somatic Function of the Tampa Scale for Kinesiophobia (score 17-68). Higher scores indicate greater kinesiophobia. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Postoperative day 5
Secondary Score on Activity Avoidance and Somatic Function of the Tampa Scale for Kinesiophobia (score 17-68). Higher scores indicate greater kinesiophobia. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 6 weeks postoperative
Secondary Score on Activity Avoidance and Somatic Function of the Tampa Scale for Kinesiophobia (score 17-68). Higher scores indicate greater kinesiophobia. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 6 months postoperative
Secondary Score on Activity Avoidance and Somatic Function of the Tampa Scale for Kinesiophobia (score 17-68). Higher scores indicate greater kinesiophobia. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 1 year postoperative
Secondary Score on Activity Avoidance and Somatic Function of the Tampa Scale for Kinesiophobia (score 17-68). Higher scores indicate greater kinesiophobia. Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 2 years postoperative
Secondary Global Score of the Pittsburgh Sleep Quality Index (0-21). Higher scores indicate a worse sleep quality (>5 indicates "poor sleeper"). Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Baseline
Secondary Global Score of the Pittsburgh Sleep Quality Index (0-21). Higher scores indicate a worse sleep quality (>5 indicates "poor sleeper"). Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Postoperative day 1
Secondary Global Score of the Pittsburgh Sleep Quality Index (0-21). Higher scores indicate a worse sleep quality (>5 indicates "poor sleeper"). Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Postoperative day 2
Secondary Global Score of the Pittsburgh Sleep Quality Index (0-21). Higher scores indicate a worse sleep quality (>5 indicates "poor sleeper"). Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. Postoperative day 5
Secondary Global Score of the Pittsburgh Sleep Quality Index (0-21). Higher scores indicate a worse sleep quality (>5 indicates "poor sleeper"). Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 6 weeks postoperative
Secondary Global Score of the Pittsburgh Sleep Quality Index (0-21). Higher scores indicate a worse sleep quality (>5 indicates "poor sleeper"). Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 6 months postoperative
Secondary Global Score of the Pittsburgh Sleep Quality Index (0-21). Higher scores indicate a worse sleep quality (>5 indicates "poor sleeper"). Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 1 year postoperative
Secondary Global Score of the Pittsburgh Sleep Quality Index (0-21). Higher scores indicate a worse sleep quality (>5 indicates "poor sleeper"). Completed by patient in verbal patient arm and by parent of the patient in non-verbal patient arm. 2 years postoperative
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