Comprehensive Study of Post-surgical Pain After Pectus or Spine Surgery

Pain, Postoperative Clinical Trial

Official title:

Genetic, Epigenetic, Psychosocial, and Biological Determinants of Post-surgical Pain After Pectus or Spine Surgery

Clinical Trial Details — Status: Enrolling by invitation

Administrative data

• NCT number: NCT04031716
• Other study ID #: 2017-5817
• Status: Enrolling by invitation
• Phase: N/A
• Start date: July 6, 2018
• Est. completion date: December 31, 2024

Study information

• Verified date: January 2024
• Source: Children's Hospital Medical Center, Cincinnati
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This will be a prospective study to determine the association between specific genotypes, epigenetics, behavioral, social and biological factors, with the phenotypes, defined by pain perception, postoperative pain, analgesic effects, side effects to perioperative analgesics, chronic postoperative pain, and gene expression in patients following pectus excavatum repair.

Description:

This study will be a clinical prospective study. It is observational for all aims except with regard to the Meditation Intervention, which will be limited to 100 pectus and 100 spine participants (randomized to 50/50 in each arm). We will recruit 600 qualifying participants over the study period to acquire the necessary data to derive a predictive model matching phenotype to genotype. This study will not interfere with the standard anesthetic or perioperative care except for blood sampling from an indwelling line, and the use of additional integrative health procedures (focused-attention meditation guidance, as well as routine massage and breathing techniques) for the randomized meditation group. Research staff will administer psychosocial and somatosensory assessments, as well as record relevant data from participant's medical records. Integrative health will assist in teaching focused-attention meditation to the randomized meditation participants in the preoperative phase. Actigraphy devices will be provided to all participants, and MUSETM to those in the randomized meditation group. The pain team, in accordance with the Pectus Pain Management Protocol, will direct perioperative pain management.

Recruitment information / eligibility

• Status: Enrolling by invitation
• Enrollment: 600
• Est. completion date: December 31, 2024
• Est. primary completion date: December 31, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 8 Years and older

Eligibility

Inclusion Criteria:

• Children aged 8 years of age through adulthood
• Diagnosis of pectus excavatum or adolescent idiopathic scoliosis
• Scheduled for endoscopic pectus excavatum repair or spine fusion

Exclusion Criteria:

• History of or active renal or liver disease
• Major surgery requiring opioids in the last 5 years
• Severe respiratory problems (such as obstructive sleep apnea, cystic fibrosis, pulmonary fibrosis, or pneumonia within the last month)
• Cardiac conditions including, but not limited to, cyanotic heart disease, hypoplastic left ventricle, arrhythmia, hypertension with ongoing treatment, Kawasaki disease, or cardiomyopathies. Participants with asymptomatic valvular lesions or defects may be included
• History of seizures currently treated on medication (participants off medication and seizure free for greater than one year may be included)
• Taking no more than two concomitant medications known to induce or inhibit CYP2D6 activity, including paroxetine, fluoxetine, cimetidine, and duloxetine
• Needing postoperative ventilation or intraoperative cardiac bypass standby
• BMI >35
• Pregnant or breastfeeding females
• Non-English speaking
• Definite developmental delay

Related Conditions & MeSH terms

• Excavatum, Pectus
• Funnel Chest
• Pain, Postoperative
• Scoliosis
• Scoliosis Idiopathic

Intervention

Behavioral:
• Meditation
Participants assigned to the Meditation intervention will receive focused attention meditation training preoperatively, and encouraged to meditate for 20 minutes per day before surgery. In the postoperative inpatient period, the participants will be offered standard holistic health care, reinforcement of meditation training, and encouragement to practice at least 20 minutes of guided focused-attention meditation with breath as their focus, utilizing the MUSETM headband for bio-feedback, every day during their hospital stay. They will be asked to continue using the MUSETM neurofeedback-assisted meditation after hospital discharge, until their visit to repeat pain testing, at which time they will return the MUSETM headband.

Locations

Country	Name	City	State
United States	Cincinnati Childrens Hospital Medical Center	Cincinnati	Ohio

Sponsors (1)

Lead Sponsor	Collaborator
Children's Hospital Medical Center, Cincinnati

Country where clinical trial is conducted

United States, 

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* Note: There are 204 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Pain score trajectory	Pain scores will be collected preoperatively through 1 year postoperatively	1 year
Primary	Changes in self-reported psychosocial scores (including anxiety, pain, coping, physical limitation, etc.)	Psychosocial measures will be collected preoperatively through 1 year postoperatively	1 year
Primary	Changes in heart rate variability	Heart rate variability will be assessed preoperatively and postoperatively	8 weeks
Primary	Changes in mean amplitude values for lower, upper, and entire alpha frequency bands by group (intervention/no intervention) and time (pre-surgery/post-surgery)	Brain activity will be assessed preoperatively and postoperatively	8 weeks
Primary	Changes in evoked response potentials (ERPs) during meditation and experimental pain tasks	Brain activity will be assessed preoperatively and postoperatively	8 weeks
Primary	Changes in sleep efficiency/duration (actigraphy) and self-reported sleep quality	Sleep efficiency and quality will be assessed preoperatively and postoperatively	8 weeks
Primary	Incidence of side-effect measures	Incidences of respiratory depression, sedation, postoperative nausea and vomiting will be collected during the recovery phase	72 hours postoperatively
Secondary	Changes in pressure pain threshold, conditioned pain modulation, tactile discrimination, and temporal summation index	Quantitative sensory testing will be assessed preoperatively and postoperatively	8 weeks