Group-based trajectory analysis of acute pain after spine surgery and risk factors for rebound pain

Abstract

BackgroundThis retrospective study was designed to explore the types of postoperative pain trajectories and their associated factors after spine surgery.Materials and methodsThis study was conducted in a single medical center, and patients undergoing spine surgery with intravenous patient-controlled analgesia (IVPCA) for postoperative pain control between 2016 and 2018 were included in the analysis. Maximal pain scores were recorded daily in the first postoperative week, and group-based trajectory analysis was used to classify the variations in pain intensity over time and investigate predictors of rebound pain after the end of IVPCA. The relationships between the postoperative pain trajectories and the amount of morphine consumption or length of hospital stay (LOS) after surgery were also evaluated.ResultsA total of 3761 pain scores among 547 patients were included in the analyses and two major patterns of postoperative pain trajectories were identified: Group 1 with mild pain trajectory (87.39%) and Group 2 with rebound pain trajectory (12.61%). The identified risk factors of the rebound pain trajectory were age less than 65 years (odds ratio [OR]: 1.89; 95% CI: 1.12–3.20), female sex (OR: 2.28; 95% CI: 1.24–4.19), and moderate to severe pain noted immediately after surgery (OR: 3.44; 95% CI: 1.65–7.15). Group 2 also tended to have more morphine consumption (p < 0.001) and a longer length of hospital stay (p < 0.001) than Group 1.ConclusionThe group-based trajectory analysis of postoperative pain provides insight into the patterns of pain resolution and helps to identify unusual courses. More aggressive pain management should be considered in patients with a higher risk for rebound pain after the end of IVPCA for spine surgery.

Medicines for Managing Lower Pain in Patients With Failed Back Surgery Syndrome Treated With Neuromodulation

“…The literature suggests possible factors that contribute to the inadequate treatment of postoperative pain, including intense pain and the previous and prolonged use of opioids. 13 The use of drugs in the treatment of low back pain is aimed at symptomatic relief. Several studies have evaluated the analgesic effects of non-steroidal anti-inflammatory drugs (NSAIDs), opioids, antidepressants, and anticonvulsants in the management of acute and chronic low back pain.…”

Disability and pain after anterior cervical decompression and fusion: A group-based trajectory analysis

“…While most of the patients have shown pain relief and improved functioning, smaller groups showed worse outcomes. [10][11][12][13][14] Among factors associated with worse outcome, younger age, female sex, worse pain before and immediately after surgery, 12 and pain catastrophizing have been reported. 13 In turn, psychological flexibility and postoperative pain acceptance have been suggested as factors predicting better outcome.…”