Pain Management Education Reduces Pain Intensity and Anxiety in Lumbar Surgery

Pain intensity, anxiety, and disability among adult patients following lumbar surgery were decreased with physical and psychological pain management training. These findings were published in The Spine Journal.

Researchers sought to examine the effect of pain management education on pain intensity, anxiety, and disability following lumbar surgery.

They conducted a parallel group (1:1) design randomly assigned controlled trial from 2018 to 2019 that included 70 patients (aged mean 45.66±7.51 years; 42.9% women) with lumbar canal stenosis and lumbar disc herniation. Participants were treated in 2 hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran.

Inclusion criteria included those aged 30 to 65 years who had undergone single level lumbar fusion during the past 4 to 8 weeks, and had an Oswestery Disability Index (ODI) of at least 26, and chronic pain for more than 6 months. Patients missing more than 2 training sessions, with chronic physical diseases, disabling mental diseases, and participation in previous similar studies were excluded.

Patients were randomized into the intervention (n=35) or control group (n=35). Intervention group participants received 7 in-person pain management training sessions twice a week for 60 to 90 minutes per session. The training team included a physician trained in sports medicine with experience in musculoskeletal rehabilitation who supervised physical exercises, and a psychiatric nurse with experience in pain management. Psychological education included psychological factors affecting the chronicity of pain, stress management, problem-solving, effective communication, and anger management.

Routine care was given to participants in the control group. After discharge they were asked not to participate in other educational programs for 3 months.  All participants completed the Numeric Rating Scale, ODI, and Pain Anxiety Symptoms Scale (PASS) study instruments before, immediately after, and 3 months after the study. All patients were blinded to patient group assignments and were unaware of the nature of the intervention. Surgeons and statistical evaluators were blinded to treatment assignments.

They used effect sizes and repeated-measures multivariate analysis of variance (MANOVA) to analyze treatment effects. They used minimal detectable change (MDC) to characterize clinical outcome for pain intensity and PASS.

Researchers found significant differences between study groups on ratings of pain intensity, anxiety, and disability. For the intervention group, MDC showed the mean differences of pain intensity were clinically improved (preintervention/immediately after intervention, 3.26 vs control group, 1.69; immediately after/3 months after, 2.14 vs control group 2.34; all P <.001). According to MANOVA, patients in the intervention group vs control group improved significantly in pain intensity scores (F=19.56, P <.001; partial ɳ²=0.478) with a large effect size.

Mean differences in pain anxiety between the 3 different times in the study groups did not exceed the MDC which suggests clinical improvements were not significant (preintervention/immediately after intervention, 17.50, P <.001 vs control group, -4.48, P =.013; immediately after/3 months after, 6.06 vs control group, 8.40, all P <.001). According to MANOVA, patients in the intervention group vs control group showed significant statistical improvement in ratings of pain anxiety (F=105.501, P <.001, partial ɳ²=0.83).

Study limitations include underpowered sample size, the exclusion of multilevel fusion surgeries, unaccounted-for factors of smoking behavior, psychological history, and previous surgeries, exclusive use of self-reported measures, inability to interpret clinical significance for pain disability, limited generalizability of results, and unmeasured long-term effectiveness of intervention.

“Physical and psychological pain management education was shown to be effective in decreasing pain intensity, anxiety, and disability,” researchers concluded. They wrote “Multidisciplinary pain management training is a promising method to improve pain intensity, anxiety, and disability for patients with spinal fusion surgery.” They recommend this nonpharmacological approach for this population of patients.

This article originally appeared on Psychiatry Advisor