Risk Factors for Postoperative Pain Intensity in Patients Undergoing Lumbar Disc Surgery: A Systematic Review

Abstract

ObjectivesPain relief has been shown to be the most frequently reported goal by patients undergoing lumbar disc surgery. There is a lack of systematic research investigating the course of postsurgical pain intensity and factors associated with postsurgical pain. This systematic review focuses on pain, the most prevalent symptom of a herniated disc as the primary outcome parameter. The aims of this review were (1) to examine how pain intensity changes over time in patients undergoing surgery for a lumbar herniated disc and (2) to identify socio-demographic, medical, occupational and psychological factors associated with pain intensity.MethodsSelection criteria were developed and search terms defined. The initial literature search was conducted in April 2015 and involved the following databases: Web of Science, Pubmed, PsycInfo and Pubpsych. The course of pain intensity and associated factors were analysed over the short-term (≤ 3 months after surgery), medium-term (> 3 months and < 12 months after surgery) and long-term (≥ 12 months after surgery).ResultsFrom 371 abstracts, 85 full-text articles were reviewed, of which 21 studies were included. Visual analogue scales indicated that surgery helped the majority of patients experience significantly less pain. Recovery from disc surgery mainly occurred within the short-term period and later changes of pain intensity were minor. Postsurgical back and leg pain was predominantly associated with depression and disability. Preliminary positive evidence was found for somatization and mental well-being.ConclusionsPatients scheduled for lumbar disc surgery should be selected carefully and need to be treated in a multimodal setting including psychological support.

PREPARE: presurgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial

“…Considering predictors for outcome in spinal-surgery, many have recommended pre-surgery screening of psychosocial factors and use of psychosocially focused intervention [30,32,43]. In addition, recently, routine use of screening-tools for and treatment of depression during waitinglist time were recommended in a systematic review [44]. To our knowledge, these recommendations have not yet been studied.…”

“…The pre-surgery intervention with education and home exercises [11,12] have shown to be sufficient for the homogenous groups studied. While a pre-surgery selection and tailor made intervention with psychological support [44], analgesic treatments [12] and more specific exercise programs as for spinal stenosis [40] and TBC might be useful for those with known risk factors.…”

Der lumbale Bandscheibenvorfall – Spontanverlauf, Therapieoptionen und klinische Ergebnisse

“…Exemplarisch für die große Zahl von Einzelstudien über die Einflussfaktoren wurde im Rahmen eines systematischen Reviews überprüft, wie der Schmerzverlauf nach lumbaler Bandscheibenoperation ist [20].…”

“…Zusätzlich fanden sich Hinweise auf einen Einfluss einer Somatisierungsstörung und der prätherapeutischen mentaler Gesundheit. Persistierender Schmerz nach Operation eines lumbalen Bandscheibenvorfalls wird unter anderem bei Patienten mit psychischen Veränderungen beschrieben [15,20]. Allerdings sind die Ergebnisse dazu in der Literatur nicht einheitlich.…”

Pre-surgery physiotherapy and pain thresholds in patients with degenerative lumbar spine disorders

“…After surgery for LDH, continued post-surgery pain is most strongly associated with depression (34), and depression is a prognostic factor for disability after surgery for spinal stenosis (35). Other psychosocial factors associated with a poor post-surgery outcome for patients with LDH are anxiety (36), passive avoidance coping strategies (37,38), fear of movement/(re)injury, and negative outcome expectations (37).…”