Pain Interference Influence on Postoperative Clinical Trajectory in Patients Undergoing Lumbar Decompression

Nie, James W.; Hartman, Timothy J.; Oyetayo, Omolabake O; MacGregor, Keith R; Zheng, Eileen; Singh, Kern

doi:10.1016/j.wneu.2022.10.122

Cited by 2 publications

(5 citation statements)

References 16 publications

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“…The study demonstrated that patients with higher preoperative pain interference (PI) scores were more likely to achieve MCID in 6 weeks for both PI and ODI following lumbar decompression surgery. 40 In contrast to the aforementioned studies, we did not observe that pre-operative survey scores, when adjusted for other factors, predicted which patients would demonstrate early clinically meaningful improvement. This could be attributed to differing definitions of early improvement, as we used a time of six months to dichotomize our responder population.…”

Section: Discussioncontrasting

confidence: 99%

“…Nie et al investigated the role of PROMIS PI scores in the ability to achieve MCID at 6 weeks, 12 weeks, 6 months, 1 year, and 2-year follow-up periods. The study demonstrated that patients with higher preoperative pain interference (PI) scores were more likely to achieve MCID in 6 weeks for both PI and ODI following lumbar decompression surgery 40 . In contrast to the aforementioned studies, we did not observe that pre-operative survey scores, when adjusted for other factors, predicted which patients would demonstrate early clinically meaningful improvement.…”

Section: Discussioncontrasting

confidence: 94%

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Clinical Improvement After Lumbar Fusion

Shaikh

Cady-McCrea

Menga

et al. 2023

Spine

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Study Design. Retrospective review of a single institution cohort.Objective. The goal of this study is to identify features that predict delayed achievement of minimum clinically important difference (MCID) following elective lumbar spine fusion using Patient-Reported Outcomes Measurement Information System (PROMIS) surveys. Summary of Background Data. Preoperative prediction of delayed recovery following lumbar spine fusion surgery is challenging. While many studies have examined factors impacting the achievement of MCID for patient-reported outcomes in similar cohorts, few studies have assessed predictors of early functional improvement. Methods. We retrospectively reviewed patients undergoing elective one-level posterior lumbar fusion for degenerative pathology. Patients were subdivided into two groups based on achievement of MCID for each respective PROMIS domain either before six months ("early responders") or after six months ("late responders") following surgical intervention. Multivariable logistic regression analysis was used to determine features associated with odds of achieving distribution-based MCID before or after six months follow up. Results. 147 patients were included. The average age was 64.3 ± 13.0 years. At final follow-up, 57.1% of patients attained MCID for PI and 72.8% for PF. However, 42 patients (49.4%) reached MCID for PI by six months, compared to 44 patients (41.1%) for PF. Patients with severe symptoms had the highest probability of attaining MCID for PI (OR 10.3; P = 0.001) and PF (OR 10.4; P = 0.001) Preoperative PROMIS symptomology did not predict early achievement of MCID for PI or PF. Patients who received concomitant iliac crest autograft during their lumbar fusion had increased odds of achieving MCID for PI (OR 8.56; P = 0.001) before six months. Conclusion. Our study demonstrated that the majority of patients achieved MCID following elective one-level lumbar spine fusion at long-term follow-up, although less than half achieved this clinical benchmark for each PROMIS metric by six months. We also found that preoperative impairment was not associated with when patients would achieve MCID. Further prospective investigations are warranted to characterize the trajectory of clinical improvement and identify the risk factors associated with poor outcomes more accurately.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 94%

Clinical Improvement After Lumbar Fusion

Shaikh

Cady-McCrea

Menga

et al. 2023

Spine

View full text Add to dashboard Cite

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“…Dunn et al, on the other hand, found that using the Catastrophizing Pain Scale, higher pain scores did not affect postoperative opioid utilization, even though they correlated with higher postoperative pain [ 11 ]. Most recently, Nie et al found patients with greater pain interference preoperatively had a greater probability of achieving minimum clinically important differences in postoperative pain interference, pain, and disability outcomes, when compared to patients with lower preoperative pain interference scores [ 5 ]. These studies are similar to our findings, demonstrating how pain scoring can be helpful in outcome predictions and pain management algorithms.…”

Section: Discussionmentioning

confidence: 99%

“…Most recently, Nie et al found patients with greater pain interference preoperatively had a greater probability of achieving minimum clinically important differences in postoperative pain interference, pain, and disability outcomes, when compared to patients with lower preoperative pain interference scores [5].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have established that patients undergoing lumbar decompression and fusion procedures who exhibit elevated levels of pain interference prior to surgery are more likely to experience clinically significant improvement in both pain and physical function postoperatively [ 5 ]. However, the relationship between preoperative pain interference, intensity, and opioid consumption in the early postoperative period remains uncharted.…”

Section: Introductionmentioning

confidence: 99%

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The Relationship Between Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Pain Intensity Scores and Early Postoperative Pain and Opioid Consumption After Lumbar Fusion

Rana,

Brennan,

Johnson

et al. 2024

Cureus

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Background The Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and pain intensity measures quantify separate dimensions of pain from the patient's perspective. This study aimed to assess differences in these outcomes and to evaluate whether baseline PROMIS pain scores could be used as a leading indicator of increased pain and opioid consumption during early recovery after lumbar fusion. Methods A retrospective review of 199 consecutive patients undergoing posterolateral fusion (PLF) at a single institution was performed. All patients underwent one to three level lumbar PLF and preoperatively completed the PROMIS pain intensity and PROMIS pain interference measures. Multivariate linear regression was used to assess the relationship between preoperative PROMIS scores and postoperative pain numeric rating scale (NRS) and oral morphine milligram equivalents (OMME) by day after controlling for age, sex, and body mass index (BMI). Results In comparison to patients with the lowest preoperative pain intensity scores, those with the highest scores required significantly more OMME on postoperative day (POD) zero and one (both p<0.05) and had higher pain NRS on POD one (p=0.02). Patients with the highest pain interference scores reported higher pain NRS on POD zero (p=0.02) but required similar OMME at all time points. After controlling for age, sex, and BMI, each one-point increase in preoperative PROMIS pain interference scores was associated with increased OMME on POD zero (β=0.29, p=0.04) and POD one (β=0.64, p=0.03). Conclusions Patients with high pain intensity reported higher levels of pain and required more opioids during the first 24 hours postoperatively, while those with high pain interference reported higher levels of pain on the day of surgery but utilized similar amounts of opioids. After risk adjustment, increased baseline PROMIS pain interference scores - but not pain intensity - were associated with increased opioid use. These results suggest that both measures should be considered when identifying patients at risk for increased pain and opioid consumption after PLF.

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Pain Interference Influence on Postoperative Clinical Trajectory in Patients Undergoing Lumbar Decompression

Cited by 2 publications

References 16 publications

Clinical Improvement After Lumbar Fusion

Clinical Improvement After Lumbar Fusion

The Relationship Between Preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Pain Intensity Scores and Early Postoperative Pain and Opioid Consumption After Lumbar Fusion

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