Persistent Spinal Pain Syndrome Type 2 (PSPS-T2), a Social Pain? Advocacy for a Social Gradient of Health Approach to Chronic Pain

Abstract

The Social Gradient of Health (SGH), or position in the social hierarchy, is one of the major determinants of health. It influences the development and evolution of many chronic diseases. Chronic pain dramatically affects individual and social condition. Its medico-economic impact is significant and worldwide. Failed Back Surgery Syndrome or Persistent Spinal Pain Syndrome type 2 (PSPS-T2) represents one of its most fascinating and disabling conditions. However, the influence of SGH on PSPS-T2 has been poorly explored. We designed a prospective multicentric study (PREDIBACK study) to assess the SGH prevalence, and to examine its association with medical and psychological variables, in PSPS-T2 patients. This study included 200 patients to determine the SGH association with pain (NPRS), Quality of life (EQ-5D-5L), kinesiophobia (FABQ-Work), catastrophism (CSQ), and functional capacity (ODI). Around 85.3% of PSPS-T2 patients in our study had low SGH. Low SGH patients had a higher FABQ-Work and CSQ-Catastrophizing score than high SGH patients (p < 0.05). High SGH patients have a higher ODI score than low SGH patients (p < 0.10). Our results suggest that SGH is a relevant factor to guide prevention, research, and ultimately intervention in PSPS-T2 patients and could be more widely transposed to chronic pain.

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

“…By contrast, males who perceive their work as physical were more impacted by disability than pain intensity. Corroborating the latter findings, Naiditch et al [9] reported that low Social Gradient of Health (SGH), concept used to describe the relationship between socioeconomic position and health, were overrepresented in PSPS-T2 patients (85.3%) in comparison with the general population (62.8%). PSPS-T2 patients with low SGH also presented the specificity of having significantly higher kinesiophobia, catastrophizing, and functional disability score than high SGH counterparts.…”

“…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].…”

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

“…Although the multidimensionality of chronic pain has been well-established [31][32][33] and reinforced by the biopsychosocial model [34,35] and the fear-avoidance model [36], pain management remains mainly focused on pain intensity relief. The vast majority of comparative pain research works are based on primary outcomes focused on pain reduction scores (VAS or NPRS).…”

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

“…PSPS-T2 incidence remains devastating, affecting 10 to 40% of operated spine patients [5,6]. This generates severe social [7], financial and psychological burdens for a significant number of patients [8]. 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].…”