Finite Mixture Models Based on Pain Intensity, Functional Disability and Psychological Distress Composite Assessment Allow to Identify Two Distinct Classes of Persistent Spinal Pain Syndrome after Surgery Patients Related to Their Quality of Life

Abstract

Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), (Failed Back Surgery Syndrome), dramatically impacts on patient quality of life, as evidenced by Health-Related Quality of Life (HRQoL) assessment tools. However, the importance of functioning, pain perception and psychological status in HRQoL can substantially vary between subjects. Our goal was to extract patient profiles based on HRQoL dimensions in a sample of PSPS-T2 patients and to identify factors associated with these profiles. Two classes were clearly identified using a mixture of mixed effect models from a clinical data set of 200 patients enrolled in “PREDIBACK”, a multicenter observational prospective study including PSPS-T2 patients with 1-year follow-up. We observed that HRQoL was more impacted by functional disability for first class patients (n=136) and by pain perception for second class patients (n=62). Males that perceive their work as physical were more impacted by disability than pain intensity. Lower education level, lack of adaptive coping strategies and higher pain intensity were significantly associated with HRQoL being more impacted by pain perception. The identification of such classes allows for a better understanding of HRQoL dimensions and opens the gate towards optimized health-related quality of life evaluation and personalized pain management.

Machine Learning Algorithms Provide Greater Prediction of Response to Scs Than Lead Screening Trial: A Predictive AI-Based Multicenter Study

“…Our logistic regression model shows that patients with higher levels of depressive symptoms are less likely to benefit from SCS whereas patients with a higher perceived health-related quality of life (EQ-5D) are more likely to achieve a good outcome following SCS. This corroborates our findings from a previous work identifying two distinct patient profiles [15], for which depression was associated with lower level of activity, resulting in lower quality of life these profiles are considered as pejorative SCS outcome predictors in a recent sociological paper focusing on socio-professional status of PSPS patients [58].…”

“…Given this context, PSPS-T2 patients are referred to a large panel of therapies through multidisciplinary team pain management and when refractory, they can be successfully treated with Spinal Cord Stimulation (SCS) [9][10][11][12][13][14]. SCS outcomes rely on patient selection, which remains challenging since implanters have to face the nature of pain, infiltrating all dimensions of patient quality of life [15], defining different trajectories for different patient profiles, and impacting the most vulnerable refractory PSPS patients, potentially eligible to SCS, with an extreme variety of clinical presentations.…”

“…Using our experience of multidimensional composite pain assessment and previous predictive research [15,23], we hypothesized that machine learning models, based on homogeneous data pooled from several multicenter studies, could be used as robust screening tools to predict SCS efficacy. To test this hypothesis, we developed, for the purpose of this study, several algorithms designed to confront model predictions and to compare our model performances to lead trial results among 103 implanted patients.…”

A Novel Multi-dimensional Clinical Response Index Dedicated to Improving Global Assessment of Pain in Patients with Persistent Spinal Pain Syndrome After Spinal Surgery, Based on a Real-life Prospective Multicentric Study (PREDIBACK) and Machine Learning

“…This pain entity, previously named Failed Back Surgery Syndrome, was recently classified as Persistent Spinal Pain Syndrome type 2 (PSPS-T2) [6,7]. Like other types of pain, PSPS-T2 is considered as an unpleasant sensory and emotional experience influenced by biological, psychological, and social factors, which leads to a decrease in health-related Quality of Life (QoL) [7][8][9][10]. PSPS-T2 constitutes a major public health issue and a considerable financial burden for society [11].…”

“…These numeric scales massively influence daily pain practice (as an example, change in opioid prescription is traditionally based on NPRS≥4), they serve as reference cut-offs to recommend, or not, eligibility to therapies (as another example, a pain decrease ≥50% on VAS must be observed on a chronic refractory patient in order to consider a Spinal Cord Stimulation (SCS) trial successful and to permanently implant a patient with SCS [17,18]. Their main advantage is to be simple to use, but their major limitation is to fail to consider more than one of the several different dimensions of pain, such as functional disability [10,[19][20][21] or psychological distress [2, 10,22].…”