Date of Completion


Embargo Period



Adolescents, Spinal Fusion, Persistent Postoperative Pain, RNA-Sequencing

Major Advisor

Dr. Angela Starkweather

Associate Advisor

Dr. Kyle Baumbauer

Associate Advisor

Dr. Erin Young

Field of Study



Doctor of Philosophy

Open Access

Open Access


Each year, millions of children and adolescents undergo surgical procedures that put them at risk for experiencing persistent postsurgical pain (PPP). This dissertation focuses on identifying relationships among pre­surgical behavioral and psychosocial factors, peripheral and central pain sensitivity, and differential mRNA expression levels. The concurrent examination of each of these factors is novel and may lead to new targeted interventions to manage PPP in children undergoing spinal fusion (SF). The overall structure of this dissertation is a five-manuscript format. The outline is as follows: [1] Introduction, which introduces the aims, theoretical framework and purpose of the dissertation; [2] Integrative literature review concerning the biopsychosocial predictive factors responsible for transition to PPP in children after SF; [3] Metasynthesis of the qualitative literature concerning the child’s firsthand experience of pain after SF; [4] Prospective study investigating the biopsychosocial factors, with emphasis on pain catastrophizing, experimental pain thresholds, and genetic expression profiles, associated with the development of PPP after SF; [5] Conclusion synthesizing the previous chapters, including future research, recommendations and limitations.

The prospective study utilized a modified biopsychosocial model to study chronic pain, thirty­-six adolescents were recruited prior to SF at two free­standing children's hospitals. In this prospective longitudinal study, data was collected at baseline (preoperative), and at the individual’s follow up appointments with the orthopedic surgeon (± 1 month and ± 4-6 months). Participants were asked to complete study questionnaires, undergo quantitative sensory testing (QST) to measure pain sensitivity, as well as undergo venipuncture for RNA sequencing. Results of the study demonstrate that preoperative increased pain intensity and helplessness were significant predictors of PPP, while differential expression of genes of the HLA complex and genes regulating chemokine receptors were identified between the PPP and non-PPP group. This knowledge may accelerate the development of precision pain management for patients undergoing SF, and possibly, other populations at risk for PPP, such as critically ill patients.