Predicting Pain Chronicization After Spine Surgery

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Patients scheduled to undergo lumbar or cervical spine surgery were prospectively enrolled to assess the validity of several pain questionnaires in predicting postoperative pain.
Patients scheduled to undergo lumbar or cervical spine surgery were prospectively enrolled to assess the validity of several pain questionnaires in predicting postoperative pain.

The 17-item Pain Sensitivity Questionnaire (PSQ) and 13-item Pain Catastrophizing Scale (PCS) were found to be predictive of a chronically painful state in patients undergoing spine surgery in a comparable manner in a study published in Clinical Spine Surgery.

A total of 110 patients scheduled to undergo lumbar or cervical spine surgery were prospectively enrolled to assess the validity of the PSQ-total, the PSQ-minor, and PCS scores in predicting postoperative pain. The Oswestry Disability Index (ODI) and the Neck Disability Index were also used prior to surgery. Visual analog scale scores were used to assess preoperative and postoperative pain at rest and with movement. Pain chronicization was evaluated with the Neck Disability Index at 12 months after intervention.

On the first postoperative day, visual analog scale scores at rest were found to increase for high catastrophizers compared with low catastrophizers. The presurgical use of grade 2 or grade 3 opioids was associated with higher postoperative patient-controlled morphine consumption in individuals undergoing lumbar spine surgeries (39.7 ±31.0 mg vs 20.2 ±20.7 mg; P =.0037).

In individuals with ODI scores of >21, PCS, PSQ-total, and PSQ-minor scores were found to be correlated with the development of chronic pain at 12 months. PCS scores ≤31 and ≤24 could predict with 98.4% and 88.2% accuracy, respectively, a reduction in ODI scores to <30 and <20, respectively, 12 months after surgery. For individuals with PCS scores >31, the accuracy of predicting an ODI score <30 was reduced to 34.8%.

“Although the PCS confirmed its reliability in distinguishing patients with higher immediate postoperative pain at rest in comparison with the PSQ, both tools showed an ability to predict a chronically painful state as defined by the persistence of disability after lumbar spine surgery,” concluded the study authors.

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Reference

Tuna T, Boz S, Van Obbergh L, Lubansu A, Engelman E. Comparison of the pain sensitivity questionnaire and the pain catastrophizing scale in predicting postoperative pain and pain chronicization after spine surgery [published online July 21, 2018]. Clin Spine Surg. doi: 10.1097/BSD.0000000000000694

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