Do preoperative fear avoidance model factors predict outcomes after lumbar disc herniation surgery? A systematic review

Abstract

BackgroundLumbar disc herniation (LDH) surgery is usually recommended when conservative treatments fail to manage patients’ symptoms. However, many patients undergoing LDH surgery continue to report pain and disability. Preoperative psychological factors have shown to be predictive for postoperative outcomes. Our aim was to systematically review studies that prospectively examined the prognostic value of factors in the Fear Avoidance Model (FAM), including back pain, leg pain, catastrophizing, anxiety, fear-avoidance, depression, physical activity and disability, to predict postoperative outcomes in patients undergoing LDH surgery.MethodsWe performed a systematic literature review of prospective studies that measured any FAM factors preoperatively to predict postoperative outcomes for patients undergoing LDH surgery. Our search databases included PubMed, CINAHL, and PsycINFO. We assessed the quality of each included study using a certain quality assessment list. Degree of agreement between reviewers on quality assessment was examined. Results related to FAM factors in the included studies were summarized.ResultsThirteen prospective studies met our inclusion criteria. Most studies were considered high quality. Heterogeneity was present between the included studies in many aspects. The most common FAM factors examinered were baseline pain, disability and depression. In, general, depression, fear-avoidance behaviors, passive pain coping, and anxiety FAM factors appeared to have negative influence on LDH surgical outcome. Baseline back pain and leg pain appeared to have differing prognostic value on LDH surgical outcomes.ConclusionsFAM factors seem to influence LDH surgical outcomes. Patients with high levels of depression, anxiety and fear-avoidance behaviors are more likely to have poor outcomes following LDH surgery. Conversely, high levels of leg pain, but not back pain seem to be predictor for favorable LDH surgery outcome. More research is needed to determine the exact role of FAM factors on LDH surgical outcome and the value for screening for these factors.

Predictive Score Card in Lumbar Disc Herniation: Is It Reflective of Patient Surgical Success after Discectomy?

“…However, they reported that higher baseline disability, as assessed by the ODI, did correlate with surgical outcomes [ 12 ]. Another systematic review reported that patients with high levels of depression, anxiety and fear-avoidance behaviors were more likely to have poor outcomes following LDH surgery [ 13 ]. Still other studies reported that Pfirrmann’s grade [ 14 ], more laterally located discs, extrusion and protrusion herniation types, and larger fragments [ 15 ] could predict the risk of conservative treatment failure in patients with LDH.…”

Pain-related fear, disability, and the fear-avoidance model of chronic pain

“…A similar pattern of findings were observed in a review of randomized controlled trials (RCTs) of non-operative pain treatment ( k = 17), such that, among persons with chronic pain for less than 6 months, greater fear-avoidance beliefs at baseline were associated with greater levels of self-reported disability and reduced likelihood of returning to work at 1-month, 6-month, and 1-year follow-ups [17]. Third, the authors of a review of RCTs of surgical intervention for lumbar disc herniation ( k = 4) concluded that high fear-avoidance beliefs at baseline tended to be associated with poor surgical outcomes (i.e., pain, disability, return to work) [18]. Notably, of the two systematic reviews that examined associations between pain-related fear and disability as a function of pain duration [16,17], both observed greater consistency in prospective associations between pain-related fear and disability among persons with pain of shorter duration (i.e., < 3 months and < 6 months, respectively).…”

Increased Pain Catastrophizing Associated With Lower Pain Relief During Spinal Cord Stimulation: Results From a Large Post-Market Study

“…These factors can aggregate to increase overall disability leading to greater pain perception, which in turn cycles back to increase pain‐related fear and avoidance. This cycle conceptualizes the Fear Avoidance Model and has been supported in scientific literature .…”