Abstract
Background: Although psychosocial factors such as anxiety, catastrophizing, and self-efficacy have been documented to affect postoperative pain, interventions to address these variables have been limited. Instead, most surgical care pathways only turn to alternative psychosocial strategies once traditional medication management has failed. Local Problem: There is a strong family desire for a pain-related psychosocial intervention prior to major pediatric surgery. However, a variety of barriers including cost and accessibility have prevented the wider adoption of such protocols at many institutions. Specific Aims: Using idiopathic scoliosis as a model, the purpose of this study was to assess the feasibility of a novel, web-based, perioperative psychosocial intervention focused on teaching healthy coping skills and improving pain self-efficacy. Interventions: We built a comprehensive digital-health intervention consisting of 21 educational and coping skills videos delivered daily via smartphone for approximately 3 weeks throughout the perioperative period. Measures and Analysis: The intervention was administered as part of a randomized, controlled trial to all patients undergoing spine surgery for idiopathic scoliosis at a single academic institution. Eligible procedures included posterior spinal instrumented fusion (PSIF) and anterior vertebral body tethering (AVBT). Families completed questionnaires focused on pain intensity, opioid consumption, pain-related disability, and patient-reported outcomes for the first 6 weeks after surgery. Results: Forty patients were enrolled and randomized, of which 30 completed the questionnaires. The intervention did not have any quantitative effect on mean daily pain scores, opioid consumption, or patient-reported outcomes. Nevertheless, the majority of families rated the coping skills videos as helpful, and 100% of respondents were likely or very likely to recommend practicing these skills to future patients. Qualitative feedback suggested that participants perceived the intervention as a simple and effective way to practice guided alternative pain management tactics that they would not otherwise have access to. Conclusion: Psychosocial interventions targeting pain following scoliosis surgery are both feasible and well-received. Additional research is needed to further develop these pathways and rigorously assess their impact on patient outcomes. Level of Evidence: Therapeutic Level II.