Background: Spinal fusion surgery is associated with severe acute postsurgical pain and high rates of chronic
postsurgical pain in adolescents. Psychological distress, sleep disturbance, and low pain self-efficacy predict higher
acute pain and likelihood of developing chronic postsurgical pain. Interventions targeting baseline psychosocial risk
factors have potential to interrupt a negative trajectory of continued pain and poor health-related quality of life
(HRQL) over time but have not yet been developed and evaluated. This randomized controlled trial will test
effectiveness of a digital peri-operative cognitive-behavioral intervention (SurgeryPalTM) vs. education-control
delivered to adolescents and their parents to improve acute and chronic pain and health outcomes in adolescents
undergoing spine surgery.
Methods: Adolescents 12–18 years of age undergoing spinal fusion for idiopathic conditions, and their parent, will be
recruited from pediatric centers across the USA, for a target complete sample of 400 dyads. Adolescents will be
randomized into 4 study arms using a factorial design to SurgeryPalTM or education control during 2 phases of treatment:
(1) pre-operative phase (one-month before surgery) and (2) post-operative phase (1 month after surgery). Acute pain
severity and interference (primary acute outcomes) and opioid use will be assessed daily for 14 days following hospital
discharge. Chronic pain severity and interference (primary acute outcomes), as well as HRQL, parent and adolescent distress,
sleep quality, and opioid use/misuse (secondary outcomes), will be assessed at 3 months and 6 months post-surgery. Discussion: Demonstration of effectiveness and understanding optimal timing of perioperative intervention will enable
implementation of this scalable psychosocial intervention into perioperative care. Ultimately, the goal is to improve pain
outcomes and reduce reliance on opioids in adolescents after spine surgery.
