[Effects of preoperative neurobiological education on postoperative outcome : A systematic review]

Variables associated with nonresponders to high-frequency (10 kHz) spinal cord stimulation

INTRODUCTION

The use of spinal cord stimulation (SCS) therapy to treat chronic pain continues to rise. Optimal patient selection remains one of the most important factors for SCS success. However, despite increased utilization and the existence of general indications, predicting which patients will benefit from neuromodulation remains one of the main challenges for this therapy. Therefore, this study aims to identify the variables that may correlate with nonresponders to high-frequency (10 kHz) SCS to distinguish the subset of patients less likely to benefit from this intervention.

MATERIALS AND METHODS

This was a retrospective single-center observational study of patients who underwent 10 kHz SCS implant. Patients were divided into nonresponders and responders groups. Demographic data and clinical outcomes were collected at baseline and statistical analysis was performed for all continuous and categorical variables between the two groups to calculate statistically significant differences.

RESULTS

The study population comprised of 237 patients, of which 67.51% were responders and 32.49% were nonresponders. There was a statistically significant difference of high levels of kinesiophobia, high self-perceived disability, greater pain intensity, and clinically relevant pain catastrophizing at baseline in the nonresponders compared to the responders. A few variables deemed potentially relevant, such as age, gender, history of spinal surgery, diabetes, alcohol use, tobacco use, psychiatric illness, and opioid utilization at baseline were not statistically significant.

CONCLUSION

Our study is the first in the neuromodulation literature to raise awareness to the association of high levels of kinesiophobia preoperatively in nonresponders to 10 kHz SCS therapy. We also found statistically significant differences with greater pain intensity, higher self-perceived disability, and clinically relevant pain catastrophizing at baseline in the nonresponders relative to responders. It may be appropriate to screen for these factors preoperatively to identify patients who are less likely to respond to SCS. If these modifiable risk factors are present, it might be prudent to consider a pre-rehabilitation program with pain neuroscience education to address these factors prior to SCS therapy, to enhance successful outcomes in neuromodulation.

Are we educating patients about postoperative analgesics following orthopaedic surgery? A scoping review

OBJECTIVES

To identify interventions educating patients undergoing orthopaedic surgery about postoperative analgesics and explore their associated outcomes.

METHODS

A scoping review using six databases was conducted. Eligible interventions were delivered to adult patients undergoing open orthopaedic procedures that could be feasibly implemented into any setting. Content, delivery methods and outcomes for interventions were described where available.

RESULTS

Eleven studies were included. Content and delivery methods differed substantially. Eight studies aimed to reduce postoperative harm by reducing opioid consumption. Studies also explored pain control (n = 6) and patient satisfaction (n = 4). Health literacy was not assessed in any study. Previous surgical or analgesic experience was infrequently reported.

CONCLUSION

This is the first scoping review assessing globally adaptable interventions designed to educate orthopaedic patients about postoperative analgesics. A paucity of interventions was found, with a limited range of patient-centred outcomes assessed. Further research is required. Co-designed educational materials with patients is recommended.

PRACTICE IMPLICATIONS

Despite the unclear benefit, clinicians should consider providing postoperative analgesic education to patients. Well-designed education has the potential to improve quality of life at low cost with low risk. Educational material adapted to local health literacy levels and prior surgical and analgesic experience is recommended to maximise engagement and impact.