Pain Sensitivity and Pain Catastrophizing Are Associated With Persistent Pain and Disability After Lumbar Spine Surgery

Abstract

Objective To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. Design Prospective observational cohort study. Setting Academic medical center. Participants Patients (N = 68, mean ± SD age = 57.9 ± 13.1 years, N female = 40 (58.8%)) undergoing spine surgery for a degenerative condition from March 1, 2012 to April 30, 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. Interventions Not applicable. Main Outcome Measure(s) The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥ 4 and Oswestry Disability Index scores ≥ 21 at all postoperative time points. Results From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated with having persistent back pain intensity (OR = 2.0, 95% CI = 1.0; 4.1) after surgery. Increased pain catastrophizing at 6 weeks was associated with having persistent back pain intensity (OR = 1.1, 95% CI = 1.0; 1.2), pain interference (OR = 1.1, 95% CI = 1.0; 1.2), and disability (OR = 1.3, 95% CI = 1.1; 1.4). An interaction effect was not found between pain sensitivity and pain catastrophizing on persistent outcomes (p > 0.05). Conclusion(s) Findings suggest the importance of early postoperative screening for pain sensitivity and pain catastrophizing in order to identify patients at-risk for poor postoperative pain intensity, interference, and/or disability outcomes. Future research should consider the benefit of targeted therapeutic strategies for patients with these postoperative prognostic factors.

Preoperative and postoperative psychologically informed physical therapy: A systematic review of randomized trials among patients with degenerative spine, hip, and knee conditions

“…In these patients, preoperative and postoperative psychological factors significantly influence recovery (Katz, ; Katz & Seltzer, ). Specifically, studies show elevated fear of movement or pain catastrophizing, and low self‐efficacy as factors associated with poor outcomes after spine surgery and total hip and knee replacement including lower physical functioning (Archer, Seebach, Mathis, Riley, & Wegener, ; Archer et al, ; Coronado, George, Devin, Wegener, & Archer, ; Filardo et al, ; Wylde, Dixon, & Blom, ) and higher pain ratings (Archer et al, ; Burns et al, ; Coronado et al, ; Filardo et al, ; Riddle, Wade, Jiranek, & Kong, ; Vissers et al, ).…”

Quality of life and objective functional impairment in lumbar spinal stenosis: a protocol for a systematic review and meta-analysis of moderators

“…In patients with LSS, comorbid depressive disorders are frequent and higher than in controls; this type of comorbidity is often associated with worse well-being, more severe long-term disability (a combination of symptoms of pain, numbness, weakness and balance issues) and more dysfunctional coping such as lower sense of coherence, lower engagement in physical exercise, more severe pain sensitivity and more catastrophic beliefs about pain 29–32…”

Assessing psychosocial profile in the physical therapy setting

“…Since its original development, the PCS has been primarily studied in patients presenting to outpatient PT with chronic LBP (George, Calley, Valencia, & Beneciuk, 2011) and whiplash-associated disorder (Sullivan, Adams, Rhodenizer, & Stanish, 2006) and in the orthopedic postsurgical setting in patients with lower extremity trauma , status post spinal surgery (Coronado, George, Devin, Wegener, & Archer, 2015), total knee replacement (Burns et al, 2015), and upper extremity trauma (Bot, Souer, van Dijk, & Ring, 2012;Das De et al, 2013). Those individuals with high catastrophizing tend to interpret pain stimuli as threatening, dangerous, and have an inability to cope with pain in a healthy manner (Leeuw, Goossens, et al, 2007).…”