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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
600
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.
Cincinnati Childrens Hospital Medical Center
Cincinnati, Ohio, United States
Pain score trajectory
Pain scores will be collected preoperatively through 1 year postoperatively
Time frame: 1 year
Changes in self-reported psychosocial scores (including anxiety, pain, coping, physical limitation, etc.)
Psychosocial measures will be collected preoperatively through 1 year postoperatively
Time frame: 1 year
Changes in heart rate variability
Heart rate variability will be assessed preoperatively and postoperatively
Time frame: 8 weeks
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
Time frame: 8 weeks
Changes in evoked response potentials (ERPs) during meditation and experimental pain tasks
Brain activity will be assessed preoperatively and postoperatively
Time frame: 8 weeks
Changes in sleep efficiency/duration (actigraphy) and self-reported sleep quality
Sleep efficiency and quality will be assessed preoperatively and postoperatively
Time frame: 8 weeks
Incidence of side-effect measures
Incidences of respiratory depression, sedation, postoperative nausea and vomiting will be collected during the recovery phase
Time frame: 72 hours postoperatively
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Changes in pressure pain threshold, conditioned pain modulation, tactile discrimination, and temporal summation index
Quantitative sensory testing will be assessed preoperatively and postoperatively
Time frame: 8 weeks