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Wang X, Peng Y, Si Y, Hu X. Effect of wound infiltration of dexmedetomidine in lumbar spine surgery on postoperative wound pain: A meta-analysis. Int Wound J 2023; 21:e14523. [PMID: 38050653 PMCID: PMC10898393 DOI: 10.1111/iwj.14523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023] Open
Abstract
In a meta-study, we evaluated the effectiveness and security of the combination of topical anaesthetic and dexmedetomidine in the treatment of postoperative pain in patients with lumbar disease. Four databases were systematically searched for possible related articles. Only English-language research was taken into account on the Internet. Furthermore, we only took into account the studies that were published prior to 2023. Only those that fulfilled the eligibility criteria were considered: (1) in adults who were about to undergo spine operation, (2) dexmedetomidine combined with local anaesthesia, (3) Visual Analog Scale scores at 4 and 24 h after the event and (4) this was a randomized or nonrandomized, controlled study. The meta-analysis was carried out with Revman 5.3 software. A ROBINS-I-based instrument was used to evaluate controlled studies. All trials were synthesized by computing the end results with either a fixed or a random effect model, which was dependent on statistical diversity. Five trials showed a marked reduction in wound pain at 4 h after the operation in patients who were treated with dexmedetomidine for lumbar spinal surgery (MD, -0.81; 95% CI, -1.24, -0.35; p = 0.0005). In the case of lumbar spinal operations, the addition of dexmedetomidine to the postoperative treatment resulted in a marked reduction in the pain at 24 h post-operation (MD, -0.64; 95% CI, -0.79, -0.48; p < 0.0001). The quality of the data we evaluated was 'moderate' to 'good'; thus, we have limited confidence in the impact estimation, and the actual impact might be significantly different from what we had expected. Additional studies should concentrate on practices that are well known to cause severe postoperative pain, especially for cases where the improvement of pain management may lead to substantial clinical benefits in terms of reduction of morbidity or cost-effectiveness in terms of quicker healing and release.
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Affiliation(s)
- Xiaoping Wang
- Department of Anaesthesiology, People's Hospital of Chongqing Liang jiang New Area, Chongqing, China
| | - Yao Peng
- Department of Anaesthesiology, People's Hospital of Chongqing Liang jiang New Area, Chongqing, China
| | - Yao Si
- Department of Anaesthesiology, Chongqing Dazu District People's Hospital, Chongqing, China
| | - Xi Hu
- Department of Anaesthesiology, Chongqing Dazu District People's Hospital, Chongqing, China
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2
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Anwar FN, Roca AM, Medakkar SS, Loya AC, Singh K. Response to the letter to the editor entitled: "Letter: impact of body mass index on PROMIS outcomes following lumbar decompression". Acta Neurochir (Wien) 2023; 165:3961-3962. [PMID: 37843606 DOI: 10.1007/s00701-023-05805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Fatima N Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Andrea M Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Srinath S Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Alexandra C Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
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Yaari LS, Nicholas SJ, Bedford BB, Mendez-Zfass MS, Hogan DE, Haviv B, McHugh MP. Influence of Pain Sensitivity on Surgical Outcomes of Arthroscopic Rotator Cuff Repair: A Prospective Cohort Study. Am J Sports Med 2023; 51:3802-3809. [PMID: 37975517 DOI: 10.1177/03635465231208113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND The Pain Sensitivity Questionnaire (PSQ) has been found to be a valid tool, and PSQ scores have been shown to be predictive of outcomes after surgery for lumbar stenosis. The effect of pain sensitivity on outcomes of rotator cuff repair (RCR) surgery has not been examined. HYPOTHESIS PSQ scores would be associated with surgical outcomes after arthroscopic RCR surgery. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients 18 to 80 years old scheduled for RCR were consecutively enrolled. Patients with glenohumeral arthritis grade ≥2 or RCR revision surgery were excluded. PSQ was completed preoperatively. The Disabilities of the Arm, Shoulder and Hand score and American Shoulder and Elbow Surgeons score were used as patient-reported outcome measurements (PROMs), and visual analog scale pain score was documented as well. Active shoulder external rotation (ER), internal rotation, and anterior forward elevation range of motion (ROM) were recorded. PROMs and ROM measurements were recorded preoperatively and at 3 months, 6 months, and 1 year after surgery. Rotator cuff tear size, type of repair, and concomitant procedures were documented. Patients were classified as having high or normal pain sensitivity based on PSQ scores. RESULTS Of 100 enrolled patients, 38 patients were classified as having high pain sensitivity. Patients with high pain sensitivity had worse American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder and Hand scores preoperatively, 6 months postoperatively, and 1 year postoperatively (P < .01). From the preoperative assessment to 3 months postoperatively, PROMs improved more in patients with high versus normal pain sensitivity. However, for patients with high pain sensitivity, PROMs plateaued after 3 months but continued to improve for patients with normal pain sensitivity (P < .01). Visual analog scale pain scores were higher at all time points for patients with high pain sensitivity (P < .05). Preoperatively, patients with high pain sensitivity had restricted active ROM compared with patients who had normal pain sensitivity for anterior forward elevation, ER, and internal rotation (P = .009, P = .012, and P = .006, respectively). By 1 year after surgery, ER ROM was still restricted in patients with high pain sensitivity. CONCLUSION Pain sensitivity is an important factor influencing RCR outcomes. Patients with high pain sensitivity undergoing RCR showed less improvement in active ROM and worse PROMs after surgery compared with patients who had normal pain sensitivity. Preoperative PSQ may predict postoperative improvements.
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Affiliation(s)
- Lee Shaul Yaari
- Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel
- Department of Orthopedics, Faculty of Medicine, Tel-Aviv University, Israel
| | - Stephen J Nicholas
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
- New York Orthopedics, New York, New York, USA
| | - Benjamin B Bedford
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
- New York Orthopedics, New York, New York, USA
| | - Matthew S Mendez-Zfass
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
- New York Orthopedics, New York, New York, USA
| | - Daniel E Hogan
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
| | - Barak Haviv
- Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petah-Tikva, Israel
- Department of Orthopedics, Faculty of Medicine, Tel-Aviv University, Israel
| | - Malachy P McHugh
- Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA
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Wu Q, Luo Y, Han M, Li J, Kang F. The Value of Pain Sensitivity Questionnaire in Predicting Postoperative Pain in Living Kidney Donors: A Prospective Observational Study. J Pain Res 2023; 16:2899-2907. [PMID: 37641638 PMCID: PMC10460613 DOI: 10.2147/jpr.s419719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose This study aimed to investigate the value of the Pain Sensitivity Questionnaire (PSQ) for the prediction of postoperative pain and the relationship between pain sensitivity and postoperative pain in kidney donors undergoing living-related kidney transplantation. Patients and Methods A total of 148 kidney donors were selected and the preoperative pain sensitivity questionnaire was administered the day before surgery. Kidney donors were assigned to low PSQ group (PSQ < 6.5, n = 76) or high PSQ group (PSQ ≥ 6.5, n = 72). The primary endpoint was the number of patient-controlled analgesia (PCA). Other outcomes included: the incidence of acute pain, flurbiprofen axetil remediation rate, the incidence of chronic pain, neuropathic pain assessment scale (Douleur Neuropathique 4 Questions, DN4), visual analog scale (VAS) at rest after surgery as well as the correlation between PSQ and QST (Quantitative Sensory Testing). Results The low PSQ group had a significantly lower number of PCA than high PSQ group (P < 0.0001). The incidence of acute pain was 75% in low PSQ group and 100% in high PSQ group (P < 0.0001). Furthermore, flurbiprofen axetil remediation rate was lower in low PSQ group than that in high PSQ group (P = 0.042). The incidence of chronic pain was significantly lower in low PSQ group than in high PSQ group (6.6% vs 61.1%, P < 0.001). Moreover, DN4 was significantly lower in low PSQ group than that in high PSQ group (P < 0.001). The PSQ-mean was significantly negatively correlated with QST in kidney donors. VAS at rest for the low PSQ group were lower than those of the high PSQ group. Conclusion The PSQ was found to be associated with the intensity or postoperative pain and might be used to screen patients prior to living-kidney transplantation.
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Affiliation(s)
- Qixing Wu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, People’s Republic of China
| | - Yiyuan Luo
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, People’s Republic of China
| | - Mingming Han
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, People’s Republic of China
| | - Juan Li
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, People’s Republic of China
| | - Fang Kang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei City, People’s Republic of China
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Kawakami M, Takeshita K, Inoue G, Sekiguchi M, Fujiwara Y, Hoshino M, Kaito T, Kawaguchi Y, Minetama M, Orita S, Takahata M, Tsuchiya K, Tsuji T, Yamada H, Watanabe K. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar spinal stenosis, 2021 - Secondary publication. J Orthop Sci 2023; 28:46-91. [PMID: 35597732 DOI: 10.1016/j.jos.2022.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/17/2022] [Accepted: 03/29/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The Japanese Orthopaedic Association (JOA) guideline for the management of lumbar spinal stenosis (LSS) was first published in 2011. Since then, the medical care system for LSS has changed and many new articles regarding the epidemiology and diagnostics of LSS, conservative treatments such as new pharmacotherapy and physical therapy, and surgical treatments including minimally invasive surgery have been published. In addition, various issues need to be examined, such as verification of patient-reported outcome measures, and the economic effect of revised medical management of patients with lumbar spinal disorders. Accordingly, in 2019 the JOA clinical guidelines committee decided to update the guideline and consequently established a formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline, incorporating the recent advances of evidence-based medicine. METHODS The JOA LSS guideline formulation committee revised the previous guideline based on the method for preparing clinical guidelines in Japan proposed by the Medical Information Network Distribution Service in 2017. Background and clinical questions were determined followed by a literature search related to each question. Appropriate articles based on keywords were selected from all the searched literature. Using prepared structured abstracts, systematic reviews and meta-analyses were performed. The strength of evidence and recommendations for each clinical question was decided by the committee members. RESULTS Eight background and 15 clinical questions were determined. Answers and explanations were described for the background questions. For each clinical question, the strength of evidence and the recommendation were both decided, and an explanation was provided. CONCLUSIONS The 2021 clinical practice guideline for the management of LSS was completed according to the latest evidence-based medicine. We expect that this guideline will be useful for all medical providers as an index in daily medical care, as well as for patients with LSS.
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Affiliation(s)
| | | | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, Japan
| | - Miho Sekiguchi
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | - Yasushi Fujiwara
- Department of Orthopaedic Surgery, Hiroshima City Asa Citizens Hospital, Japan
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City General Hospital, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University, Japan
| | | | - Masakazu Minetama
- Spine Care Center, Wakayama Medical University Kihoku Hospital, Japan
| | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University, Japan
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Fu Q, Han M, Mu Y, Hao L, Lu L, Huang X, Li J, Kang F. Does the pain sensitivity questionnaire correlate with tourniquet pain in patients undergoing ankle surgery? Front Surg 2023; 10:1102319. [PMID: 36923376 PMCID: PMC10009183 DOI: 10.3389/fsurg.2023.1102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/06/2023] [Indexed: 03/02/2023] Open
Abstract
Background Tourniquet pain is the most prominent problem in ankle surgery, and there is no proper method to predict it. It was reported that pain sensitivity questionnaires could evaluate the pain sensitivity of subjects. Its potential to predict tourniquet pain in ankle surgery is constructive and meaningful. Methods One hundred and twenty patients undergoing ankle surgery were included in this study. The pain sensitivity questionnaire (PSQ) and self-rating anxiety scale (SAS) were completed before the operation. The methods included an ultrasound-guided popliteal sciatic, a femoral nerve block, and a proximal thigh tourniquet. The pressure of the tourniquet was set according to the systolic blood pressure (SBP + 100 mmHg). A visual analogue scale (VAS) was used to assess the tourniquet pain. Also, the onset time of tourniquet pain ≥4 VAS units was recorded. Results The PSQ-total and PSQ-minor scores were significantly correlated with the onset time when the tourniquet pain ≥4 VAS units (r = -0.763, r = -0.731, P < 0.001). The PSQ-total score <6.5 group gave significantly lower ratings for items 3, 4, 14, and 16 in the PSQ survey compared to the PSQ-total score ≥6.5 group (P < 0.05). Patients with high pain sensitivity have a higher need for analgesic drugs (P < 0.001). PSQ-total score ≥6.5 (OR = 185.8, 95% CI = 39.8-1,437.6, P < 0.001), sex (male, OR = 0.11, 95% CI = 0.018-0.488, P < 0.05), and age (OR = 0.92, 95% CI = 0.842-0.995, P < 0.05) were risk factors for reporting a tourniquet pain ≥4 VAS units within 30 min. Conclusion The PSQ score is found to be correlated with intraoperative tourniquet pain. In addition, sex and age also affect the time of having intraoperative tourniquet pain.
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Affiliation(s)
- Qiuyue Fu
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Mingming Han
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Yuyang Mu
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Lina Hao
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Liang Lu
- Department of Hand and Foot Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Xiang Huang
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Juan Li
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Fang Kang
- Department of Anesthesiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
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The Effect of the Severity of Preoperative Leg Pain on Patient-Reported Outcomes, Minimum Clinically Important Difference Achievement, and Patient Satisfaction After Minimally Invasive Transforaminal Lumbar Interbody Fusion. World Neurosurg 2022; 167:e1196-e1207. [PMID: 36075356 DOI: 10.1016/j.wneu.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare patient-reported outcome measures (PROMs), satisfaction, and minimum clinically important difference (MCID) achievement after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients stratified by preoperative leg pain. METHODS Patients undergoing MIS-TLIF were collected through retrospective review of a prospectively maintained single-surgeon database. PROMs administered preoperatively/postoperatively included Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) back/leg pain, Oswestry Disability Index (ODI), and 12-Item Short Form (SF-12) Physical/Mental Component Score (PCS/MCS). Patients were grouped based on preoperative VAS leg scores: VAS leg ≤7 or VAS leg >7. Inferential statistics were used to compare PROMs, MCID achievement rates, and postoperative satisfaction between groups. RESULTS A total of 562 patients were eligible (168 VAS leg score ≤7; 394 VAS leg score >7). Significant differences between cohorts in postoperative mean PROMs were noted for PROMIS-PF at 6 weeks/2 years, SF-12 PCS at 6 weeks/2 years, SF-12 MCS at 6 weeks/12 weeks/6 months/1 year, VAS back score at 6 weeks/12 weeks/6 months, VAS leg score at 6 weeks/12 weeks/6 months/2 years and ODI at all postoperative time points (P < 0.045, all). In the VAS leg score >7 cohort, a greater proportion achieving MCID for VAS leg score at all postoperative time points and ODI at 12 weeks (P < 0.010, all). Postoperative satisfaction was greater in VAS back score ≤7 cohort for VAS leg score at 6 weeks/12 weeks/6 months/2 years, VAS back score at 12 weeks/2 years, and ODI at 6 weeks/12 weeks/6 months/2 years (P < 0.046, all). CONCLUSIONS Patients with severe preoperative leg pain showed worse postoperative PROM scores and patient satisfaction for disability and back/leg pain. MCID achievement rates across cohorts were similar. Patients with severe leg pain may have expectations for surgical benefits incongruent with their postoperative outcomes, and physicians may seek to manage the preoperative expectations of their patients to reflect likely outcomes after MIS-TLIF.
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Study on the correlation between radiological indicators, seven-grade classification and Oswestry disability index of surgical spinal stenosis. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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9
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Meints SM, Garcia RG, Schuman-Olivier Z, Datko M, Desbordes G, Cornelius M, Edwards RR, Napadow V. The Effects of Combined Respiratory-Gated Auricular Vagal Afferent Nerve Stimulation and Mindfulness Meditation for Chronic Low Back Pain: A Pilot Study. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:1570-1581. [PMID: 35148407 PMCID: PMC9434172 DOI: 10.1093/pm/pnac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/31/2022] [Accepted: 02/05/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Respiratory-gated Auricular Vagal Afferent Nerve stimulation (RAVANS) is a safe nonpharmacological approach to managing chronic pain. The purpose of the current study was to examine (1) the feasibility and acceptability of RAVANS, combined with mindful meditation (MM) for chronic low back pain (CLBP), (2) the potential synergy of MM+RAVANS on improving pain, and (3) possible moderators of the influence of MM+RAVANS on pain. DESIGN Pilot feasibility and acceptability study. SETTING Pain management center at large academic medical center. SUBJECTS Nineteen adults with CLBP and previous MM training. METHODS Participants attended two sessions during which they completed quantitative sensory testing (QST), rated pain severity, and completed a MM+stimulation session. Participants received RAVANS during one visit and sham stimulation during the other, randomized in order. Following intervention, participants repeated QST. RESULTS MM+RAVANS was well tolerated, acceptable, and feasible to provide relief for CLBP. Both MM+stimulation sessions resulted in improved back pain severity, punctate pain ratings, and pressure pain threshold. Individuals with greater negative affect showed greater back pain improvement from MM+RAVANS while those with greater mindfulness showed greater back pain improvement from MM+sham. CONCLUSIONS Results suggest that for CLBP patients with prior MM training, the analgesic effects of MM may have overshadowed effects of RAVANS given the brief single session MM+RAVANS intervention. However, those with greater negative affect may benefit from combined MM+RAVANS.
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Affiliation(s)
- Samantha M Meints
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
| | - Ronald G Garcia
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zev Schuman-Olivier
- Center for Mindfulness and Compassion, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Michael Datko
- Center for Mindfulness and Compassion, Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Gaelle Desbordes
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Marise Cornelius
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
| | - Vitaly Napadow
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Chestnut Hill, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
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Halicka M, Duarte R, Catherall S, Maden M, Coetsee M, Wilby M, Brown C. Predictors of Pain and Disability Outcomes Following Spinal Surgery for Chronic Low Back and Radicular Pain: A Systematic Review. Clin J Pain 2022; 38:368-380. [PMID: 35413024 DOI: 10.1097/ajp.0000000000001033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Success rates of spinal surgeries to treat chronic back pain are highly variable and useable prognostic indicators are lacking. We aimed to identify and evaluate preoperative predictors of pain and disability after spinal surgery for chronic low back/leg pain. METHODS Electronic database (01/1984-03/2021) and reference searches identified 2622 unique citations. Eligible studies included adults with chronic low back/leg pain lasting ≥3 months undergoing first elective lumbar spine surgery, and outcomes defined as change in pain (primary)/disability (secondary) after ≥3 months. We included 21 reports (6899 participants), 7 were judged to have low and 14 high risks of bias. We performed narrative synthesis and determined the quality of evidence (QoE). RESULTS Better pain outcomes were associated with younger age, higher education, and no spinal stenosis (low QoE); lower preoperative pain, fewer comorbidities, lower pain catastrophizing, anxiety and depression (very low QoE); but not with symptom duration (moderate QoE), other sociodemographic factors (low QoE), disability, or sensory testing (very low QoE). More favorable disability outcomes were associated with preoperative sensory loss (moderate QoE); lower job-related resignation and neuroticism (very low QoE); but not with socioeconomic factors, comorbidities (low QoE), demographics, pain, or pain-related psychological factors (very low QoE). DISCUSSION In conclusion, absence of spinal stenosis potentially predicts greater pain relief and preoperative sensory loss likely predicts reduction in disability. Overall, QoE for most identified associations was low/very low.
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Affiliation(s)
| | - Rui Duarte
- Liverpool Reviews & Implementation Group (LRiG)
| | | | | | | | - Martin Wilby
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Kim MS, Koh IJ, Sung YG, Park DC, Yoon EJ, In Y. Influence of increased pain sensitivity on patient-reported outcomes following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:782-790. [PMID: 33486560 DOI: 10.1007/s00167-021-06455-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to discover whether increased pain sensitivity was associated with postoperative pain and patient-reported outcome measures (PROMs) after total knee arthroplasty (TKA). METHODS Pain sensitivity was evaluated preoperatively using a pain sensitivity questionnaire (PSQ). Resting, walking, nighttime, and average pain visual analog scale (VAS) were measured before surgery and 6 weeks, 3 months, 6 months, and 1 year after surgery. PROMs were also evaluated based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and patient satisfaction. The association between pain VAS average score, WOMAC total score, and PSQ score (minor, moderate, and total score) was assessed at each stage. RESULTS There were 59 patients with a high PSQ score (≥ 5.2) and 53 with a low PSQ score (< 5.2). Up to 1 year postoperatively, the group with high PSQ scores had higher resting, walking, nighttime, and average pain VAS scores than the group with low scores (all p < 0.05). Worse preoperative WOMAC pain, function, and total scores continued until 1 year after surgery in the high-scoring PSQ group (all p < 0.05). The group with low PSQ scores was more satisfied with surgery than the group with high scores (p = 0.027). There was a positive correlation between preoperative PSQ score and pain VAS average score at all time points (all p < 0.05). A relationship between PSQ score and WOMAC total score was also observed (all p < 0.05). CONCLUSION Increased pain sensitivity is a factor related to higher postoperative pain levels and inferior PROMs in patients undergoing primary TKA. LEVEL OF EVIDENCE Case-controlled study, III.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Yong Gyu Sung
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dong Chul Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Eun Ji Yoon
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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12
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Jacob KC, Patel MR, Collins AP, Ribot MA, Pawlowski H, Prabhu MC, Vanjani NN, Singh K. The Effect of the Severity of Preoperative Disability on Patient-Reported Outcomes and Patient Satisfaction Following Minimally Invasive Transforaminal Lumbar Interbody Fusion. World Neurosurg 2021; 159:e334-e346. [PMID: 34942388 DOI: 10.1016/j.wneu.2021.12.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/14/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare patient-reported outcomes (PROMs), satisfaction, and minimum clinically important difference (MCID) achievement following minimally invasive transforaminal lumbar interbody fusion stratified by preoperative disability. METHODS Minimally invasive transforaminal lumbar interbody fusions were grouped by preoperative Oswestry Disability Index (ODI) score: ODI <41 or ODI ≥41. PROMs administered pre/postoperatively included Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF), visual analog scale (VAS) back/leg, ODI, and 12-Item Short-Form Physical Composite Score (SF-12 PCS)/12-Item Short-Form Mental Composite Score (SF-12 MCS). Satisfaction scores were collected for VAS back/leg and ODI. Coarsened exact match controlled for differences between cohorts. T tests compared mean PROMs and postoperative improvement/satisfaction between cohorts. Simple logistic regression compared MCID achievement. RESULTS After coarsened exact matching, there were 118 patients in the ODI ≤41 and 377 patients in the ODI >41 cohort. The ODI >41 cohort saw greater postoperative inpatient VAS pain score and narcotic consumption on days 0/1 (P < 0.018, all). PROMs differed between cohorts: PROMIS-PF, SF-12 PCS, ODI, VAS back/leg at all postoperative time points and SF-12 MCS at 6 weeks/12 weeks/6 months/1 year (P < 0.045, all). Patients in the ODI >41 cohort demonstrated greater proportion achieving MCID for ODI at all postoperative time points and for SF-12 MCS 6-week/12-week/6-month/1-year (P < 0.040, all). The ODI ≤41 cohort demonstrated greater MCID achievement for overall PROMIS-PF and SF-12 PCS 6 months (P < 0.047, all). Postoperative satisfaction was greater in the ODI ≤41 cohort for VAS leg 6 weeks/12 weeks, VAS back 6 weeks/12 weeks, and ODI all postoperative time points (P < 0.048, all). CONCLUSIONS Preoperative disability associated with worse postoperative PROMs and patient satisfaction for disability, back/leg pain at multiple time points. MCID achievement rates across cohorts were similar for most PROMs at most postoperative time points. Patients with severe disability may have unrealistic expectations for surgical benefits, influencing corresponding postoperative satisfaction.
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Affiliation(s)
- Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Andrew P Collins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Max A Ribot
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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13
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Chen Y, Ye X, Wu H, Huang X, Ke C, Chen Y, Wu H, Wu X. Association of Postpartum Pain Sensitivity and Postpartum Depression: A Prospective Observational Study. Pain Ther 2021; 10:1619-1633. [PMID: 34580805 PMCID: PMC8586323 DOI: 10.1007/s40122-021-00325-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/08/2021] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Postpartum depression (PPD) is a severe psychiatric disorder that negatively affects postnatal mothers worldwide. The aim of the study is to investigate the association between postpartum pain sensitivity and PPD as well as to identify the other potential risk factors for PPD and their interconnections. METHODS The current study was a prospective observational clinical study that enrolled 210 singleton pregnant women in a tertiary referral hospital from January to December 2020. Postpartum pain sensitivity was assessed by the Mandarin Chinese version of the Pain Sensitivity Questionnaire (PSQ), and PSQ-C-total and PSQ-C-minor scores were collected. PPD was screened by self-reporting Edinburgh Postnatal Depression Scale (EPDS), and EPDS total score was recorded. The association between postpartum pain sensitivity and PPD, as well as the risk factors and their interconnections, was analyzed by using a combination of stratified, bivariate, correlation, receiver-operating characteristic (ROC) curve, multivariate logistic regression, and path analysis. RESULTS Overall, 87 of 210 mothers (41.4%) screened positive for PPD. A positive correlation between PSQ-C-total (r = 0.67) or PSQ-C-minor (r = 0.62) and EPDS scores was identified. PSQ-C-total [area under curve (AUC) 0.89, 95% CI 0.84-0.93; P < 0.0001] showed significantly higher diagnostic accuracy compared with PSQ-C-minor (AUC 0.85, 95% CI 0.80-0.90; P < 0.0001) in predicting EPDS scores ≥ 10 points. Multivariate logistic regression indicated that a high PSQ-C-total score [adjusted odds ratio (OR) 1.12, 95% CI 1.08-1.51; P < 0.001] and gestational diabetes (adjusted OR 2.68, 95% CI 0.96-7.47; P = 0.045) were independent risk factors, while breastfeeding (adjusted OR: 0.34, 95% CI 0.15-0.78; P = 0.007) and normal birth weight (adjusted OR 0.17, 95% CI 0.05-0.61; P = 0.0047) were independently associated with decreasing adjusted ORs for EPDS scores ≥ 10 points. The path analysis model indicated that PSQ-C-total scores and gestational diabetes showed bidirectional effects, while birth weight and breastfeeding only had a direct impact on EPDS scores ≥ 10 points. CONCLUSION Increased postpartum pain sensitivity was closely associated with EPDS scores ≥ 10 points, and PSQ-C scores could be a reliable predictor. Moreover, gestational diabetes, low occurrence of breastfeeding, and low birth weight were the risk factors for EPDS scores ≥ 10 points. TRIAL REGISTRATION ChiCTR.org.cn identifier, ChiCTR-2000033091.
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Affiliation(s)
- Yu Chen
- grid.415108.90000 0004 1757 9178Department of Anesthesiology, Jinshan Branch of Fujian Provincial Hospital, No. 516, South of Jinrong Rd, Fuzhou, 350028 China ,grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Provincial Clinical Medical College, Fujian Medical University, Fuzhou, 350001 China
| | - Xin Ye
- grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Provincial Clinical Medical College, Fujian Medical University, Fuzhou, 350001 China ,grid.415108.90000 0004 1757 9178Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Han Wu
- grid.415108.90000 0004 1757 9178Department of Anesthesiology, Jinshan Branch of Fujian Provincial Hospital, No. 516, South of Jinrong Rd, Fuzhou, 350028 China
| | - Xinlei Huang
- grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Provincial Clinical Medical College, Fujian Medical University, Fuzhou, 350001 China ,grid.415108.90000 0004 1757 9178Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Congrong Ke
- grid.415108.90000 0004 1757 9178Department of Obstetrics and Gynecology, Jinshan Branch of Fujian Provincial Hospital, Fuzhou, 350028 China
| | - Yanqing Chen
- grid.415108.90000 0004 1757 9178Department of Anesthesiology, Jinshan Branch of Fujian Provincial Hospital, No. 516, South of Jinrong Rd, Fuzhou, 350028 China ,grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Provincial Clinical Medical College, Fujian Medical University, Fuzhou, 350001 China
| | - Huanghui Wu
- Department of Anesthesiology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, No. 2000, East of Xiang'an Rd, Xiamen, 361102, China. .,Department of Anesthesiology and Perioperative Medicine, 900 Hospital of the Joint Logistics Team of the PLA, Fuzhou, 350025, China.
| | - Xiaodan Wu
- Department of Anesthesiology, Jinshan Branch of Fujian Provincial Hospital, No. 516, South of Jinrong Rd, Fuzhou, 350028, China. .,Department of Anesthesiology, Fujian Provincial Clinical Medical College, Fujian Medical University, Fuzhou, 350001, China.
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Yilmaz Inal F, Yilmaz Camgoz Y, Daskaya H, Kocoglu H. The Effect of Preoperative Anxiety and Pain Sensitivity on Preoperative Hemodynamics, Propofol Consumption, and Postoperative Recovery and Pain in Endoscopic Ultrasonography. Pain Ther 2021; 10:1283-1293. [PMID: 34292516 PMCID: PMC8586400 DOI: 10.1007/s40122-021-00292-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The present study investigates how preoperative anxiety and pain sensitivity affect the consumption of anesthetics, time elapsed until the desired sedation level is achieved, preoperative hemodynamics, postoperative recovery time, and postoperative pain. METHODS The present study includes 80 ASA 1-2 patients aged between 20 and 65 who were scheduled for endoscopic ultrasonography (EUS) under sedation. Patients were instructed to fill out the Spielberger State-Trait Anxiety Inventory (STAI) and Pain Sensitivity Questionnaire (PSQ) before the procedure. For sedation, 0.03 mg kg-1 intravenous midazolam, 1 mg kg-1 lidocaine, 1 µ kg-1 fentanyl, and then a bolus dose of 1 mg kg-1 propofol were infused over a period of 60 s. The time elapsed until the bispectral index (BIS) value reached 75 was recorded. For anesthesia maintenance, 2 mg kg-1 h-1 propofol infusion was administered. In the case of sedation failure, an additional dose of 0.1 mg kg-1 propofol (IV) was administered to ensure sedation depth with a BIS level of 65-75, and the propofol infusion was halted once the BIS value dropped below 65. RESULTS STAI-S and STAI-T scores were significantly positively correlated with PSQ minor pain and PSQ total scores. The time elapsed until reaching a BIS level of 75, propofol infusion dose used during sedation, and the need for additional doses of propofol, heart rate (HR), and duration of post-anesthesia care unit stay were significantly positively correlated with both preoperative anxiety and preoperative pain sensitivity. In terms of postoperative pain, the visual analog scale (VAS) at 1 h was more highly correlated with STAI-S and STAI-T than with PSQ. The VAS 2 h was only correlated with STAI-S and STAI-T. CONCLUSION The significant linear correlation between preoperative anxiety and pain sensitivity and anesthesia need can facilitate better preoperative management by predicting individual anesthetic consumption. TRIAL REGISTRATION The study was registered with the number NCT03114735 on ClinicalTrials.gov.
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Affiliation(s)
- Ferda Yilmaz Inal
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcın Sehir Hastanesi, Dr. Erkin Cad., Kadikoy, 34722, Istanbul, Turkey.
| | - Yadigar Yilmaz Camgoz
- Clinic of Anaesthesiology and Reanimation, Sultan Abdülhamid Han Training and Research Hospital, Selimiye mh, Tıbbiye Cd, Uskudar, 34668 Istanbul, Turkey
| | - Hayrettin Daskaya
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Bezmialem Vakif University, Iskender Pasa Mh, Adnan Menderes Blv., Fatih, 34093 Istanbul, Turkey
| | - Hasan Kocoglu
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcın Sehir Hastanesi, Dr. Erkin Cad., Kadikoy, 34722 Istanbul, Turkey
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15
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Jacob KC, Patel MR, Parsons AW, Vanjani NN, Pawlowski H, Prabhu MC, Singh K. The Effect of the Severity of Preoperative Back Pain on Patient-Reported Outcomes, Recovery Ratios, and Patient Satisfaction Following Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF). World Neurosurg 2021; 156:e254-e265. [PMID: 34583000 DOI: 10.1016/j.wneu.2021.09.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Limited literature has addressed impact of preoperative back pain severity on patient-reported outcome measures (PROMs), recovery ratios (RRs), and patient satisfaction following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). METHODS MIS TLIFs were retrospectively identified and grouped: preoperative visual analog scale (VAS) back ≤7 or VAS back >7. PROMs, including PROMIS-PF, VAS back and leg, Oswestry Disability Index (ODI), and SF-12 Physical Composite Score and Mental Composite Score (MCS), were collected pre- and postoperatively. A PROM's RR was calculated as proportion of postoperative improvement to overall potential improvement. RESULTS In total, 740 patients were included: 359 patients with VAS back ≤7 and 381 patients with VAS back >7. The VAS back >7 cohort reported significantly greater postoperative inpatient pain (P ≤ .003, both). All preoperative and the following postoperative PROMs favored the VAS back ≤7 cohort: PROMIS-PF 2-years, VAS back overall, SF-12 Physical Composite Score 12 weeks and 1 year, SF-12 MCS 6 weeks/12 weeks, VAS leg 6 weeks, 12 weeks, 6 months, and 2 years, and ODI overall (P ≤ 0.048, all). The VAS back >7 cohort demonstrated greater delta PROMs for all VAS back and ODI except 2 years (P ≤ 0.021, all). A greater proportion of patients in the VAS back >7 group achieved minimal clinically important difference for VAS back overall, ODI 6 weeks/12 weeks, PROMIS-PF 6 weeks, and SF-12 MCS 6 weeks/6 months (P ≤ 0.044, all). The VAS back>7 cohort RR was significantly greater for VAS back 6 months and VAS leg 6 months/2 years (P ≤ 0.034, all). The VAS back ≤7 cohort's postoperative satisfaction was significantly greater for VAS back 12 weeks, VAS leg 12 weeks, and ODI 6 weeks/12 weeks (P ≤ 0.046, all). CONCLUSIONS Patients with greater preoperative back pain demonstrated significantly worse postoperative scores for most PROMs at most time points and significantly worse patient satisfaction for disability, back and leg pain at multiple time points.
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Affiliation(s)
- Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander W Parsons
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Dong H, Liu H, Zhu D, Ruan B, Yu H, Xu X, Wang Y. Wound infiltration of dexmedetomidine as an adjunct to local anesthesia in postoperative analgesia for lumbar surgery: a systematic review and meta-analysis. Minerva Anestesiol 2021; 87:1034-1041. [PMID: 33982988 DOI: 10.23736/s0375-9393.21.15469-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The vast majority of patients undergoing lumbar surgery experience varying degrees of incision pain, leading to prolonged postoperative recovery and poor satisfaction with treatment. The objective of this meta-analysis was to evaluate the efficacy and safety of dexmedetomidine as an adjunct to local anesthesia for postoperative pain control after lumbar surgery. EVIDENCE ACQUISITION Two authors independently searched eligible random controlled trials in electronic databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI (China National Knowledge Infrastructure), CBM (The Chinese BioMedical database) using the search terms 'dexmedetomidine', 'infiltration', and 'lumbar'. The random-effect model was used to perform the meta-analysis based on deviance information criteria. EVIDENCE SYNTHESIS Six trials evaluating a total of 330 patients were included in this review. Wound infiltration with dexmedetomidine significantly reduced the postoperative VAS scores (4th hour static VAS scores (MD=-1.03; 95% CI: -1.58 to -0.47; p=0.0003); 24th hour static VAS scores (MD=-0.66; 95% CI: -0.91 to -0.40; p<0.00001); 6th hour dynamic VAS scores (MD=-1.84; 95% CI: -2.23 to -1.45; p<0.00001)) and total supplemental analgesic consumption (SMD=-2.01; 95% CI: -3.04 to -0.98; p<0.00001), prolonged the median time to first rescue analgesia (SMD=3.53; 95% CI:2.31 to 4.76; p<0.00001), and reduced the incidence of nausea or vomiting (RR=0.40; 95% CI: 0.17 to 0.93; P<0.05). CONCLUSIONS Dexmedetomidine infiltration appears to be a promising and safe adjunct for postoperative pain control after lumbar surgery. However, more studies are needed to assess the prevalence of other side effects.
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Affiliation(s)
- Hui Dong
- Department of Graduate School, Dalian Medical University, Dalian, China.,Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hongtao Liu
- Department of Graduate School, Dalian Medical University, Dalian, China.,Department of Urology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Dongming Zhu
- Department of Graduate School, Dalian Medical University, Dalian, China.,Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Binjia Ruan
- Department of Graduate School, Dalian Medical University, Dalian, China.,Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hang Yu
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xiaohang Xu
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yongxiang Wang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China -
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Masterclass: A pragmatic approach to pain sensitivity in people with musculoskeletal disorders and implications for clinical management for musculoskeletal clinicians. Musculoskelet Sci Pract 2021; 51:102221. [PMID: 32972875 DOI: 10.1016/j.msksp.2020.102221] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/29/2020] [Accepted: 07/04/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Research on musculoskeletal disorders indicates that pain sensitivity can be an important consideration for musculoskeletal clinicians in the holistic view of a patient presentation. However, diversity in research findings in this field can make this a difficult concept for clinicians to navigate. Limited integration of the concept of pain sensitivity into clinical practice for musculoskeletal clinicians has been noted. PURPOSE The purpose of this masterclass is to provide a framework for the consideration of pain sensitivity as a contributing factor in the presentation of people with musculoskeletal pain. It provides pragmatic synthesis of the literature related to pain sensitivity through a lens of how this information can inform clinical practice for musculoskeletal clinicians. Guidance is provided in a 'how to' format for integration of this knowledge into the clinical encounter to facilitate personalised care. IMPLICATIONS The relationship of pain sensitivity with pain and disability is not clear or linear. The real importance of pain sensitivity in a clinical presentation may be: (1) the potential for pain sensitivity to modify the effect of common treatments utilised by musculoskeletal clinicians, or (2) the effect of pain sensitivity on the prognosis/course of a disorder. Screening tools and subjective features have been highlighted to indicate when physical assessment of pain sensitivity should be prioritised in the physical examination. A pragmatic blueprint for specific assessment related to pain sensitivity has been outlined. A framework for integrating assessment findings into clinical reasoning to formulate management plans for the pain sensitive patient is provided.
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18
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The Effect of Dexmedetomidine Added to Preemptive Ropivacaine Infiltration on Postoperative Pain After Lumbar Fusion Surgery: A Randomized Controlled Trial. Spine (Phila Pa 1976) 2019; 44:1333-1338. [PMID: 31095117 DOI: 10.1097/brs.0000000000003096] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective and controlled study of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery. OBJECTIVE Assessment of dexmedetomidine added to preemptive ropivacaine infiltration for the relief of postoperative pain after lumbar fusion surgery. SUMMARY OF BACKGROUND DATA Single local anesthetic preemptive wound infiltration for the relief of postoperative pain does not translate into major or consistent clinical benefits after lumbar fusion surgery. Dexmedetomidine added to local anesthetics prolonged the duration of blockade and enhanced the analgesic in peripheral nerve block. The effect of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery for the relief of postoperative pain has yet not been studied. METHODS Fifty-seven patients with elective posterior lumbar fusion were randomly divided into two groups. Five minutes before incision, the skin and subcutaneous tissues were injected with 20 mL 0.5% ropivacaine in group R (n = 28) and 20 mL 0.5% ropivacaine and 1 ug/kg of dexmedetomidine in group RD (n = 29) in two divided doses (i.e., 10 mL per side of the incision line). After the operation, all patients received intravenous morphine for analgesia. The total morphine consumption, the time of first analgesic demand, numbers of PCA analgesia, Visual Analog Scale, and postoperative adverse effects were collected. RESULTS In group RD, cumulative morphine dose and numbers of PCA analgesia in group RD were significantly reduced, the time of first analgesic demand was significantly delayed compared to the group R. Visual Analog Scale in group RD showed a marked reduction at 8 hours, 12 hours, 16 hours after operation and less patients in group RD experienced postoperative nausea or vomiting compared to the group R. CONCLUSION The addition of dexmedetomidine to preemptive ropivacaine wound infiltration provided a superior analgesic effect, reduced postoperative morphine consumption, and prolonged the time of the first analgesic demand with no serious side effects. LEVEL OF EVIDENCE 2.
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Peng H, Tang G, Zhuang X, Lu S, Bai Y, Xu L. Minimally invasive spine surgery decreases postoperative pain and inflammation for patients with lumbar spinal stenosis. Exp Ther Med 2019; 18:3032-3036. [PMID: 31555386 PMCID: PMC6755410 DOI: 10.3892/etm.2019.7917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/06/2018] [Indexed: 12/14/2022] Open
Abstract
In certain cases, lumbar spinal stenosis may lead to lumbar nervous disorder. A previous study indicated that minimally invasive spine surgery (MISS) presents benefits compared with conventional open surgery (COS). In the current study, the efficacy of MISS and COS for lumbar spinal stenosis patients was investigated. A total of 82 patients with lumbar spinal stenosis were enrolled and divided into two age-matched groups that received MISS (n=41) or COS (n=41). Patient parameters, including symptoms, inflammatory score, visual analog score (VAS), wound length, Oswestry Disability Index (ODI), hospital stay and postoperative outcomes were analyzed in the current study. Outcomes indicated that both MISS and COS significantly improved symptoms of lumbar spinal stenosis compared with the baseline. It was observed that MISS resulted in decreased wound length and hospital stay compared with COS for patients with lumbar spinal stenosis. The results revealed that MISS had better outcomes compared with COS in improving ODI and inflammatory score for patients with lumbar spinal stenosis. Notably, it was identified that MISS exhibited improved VAS for back and leg pain compared with the COS group for patients with lumbar spinal stenosis. In conclusion, these outcomes indicate that MISS was more effective compared with COS for improving symptoms in patients with lumbar stenosis.
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Affiliation(s)
- Hui Peng
- Department of Orthopedics, Affiliated National Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Guangping Tang
- Department of Orthopedics, Wuhan Hanyang Hospital, Wuhan, Hubei 430050, P.R. China
| | - Xiaoqiang Zhuang
- Department of Orthopedics, Affiliated National Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Shenglin Lu
- Department of Orthopedics, Affiliated National Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Yu Bai
- Department of Orthopedics, Affiliated National Hospital of Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Li Xu
- Department of Traumatology, Wuhan No. 1 Hospital, Wuhan, Hubei 430022, P.R. China
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20
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Transcultural adaptation and French validation of the Pain Sensitivity Questionnaire. Can J Anaesth 2019; 66:1202-1212. [PMID: 31020630 DOI: 10.1007/s12630-019-01377-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To validate a French translation of the Pain Sensitivity Questionnaire (PSQ), which is a valuable tool to predict an individual's natural disposition to feel pain that could be used after surgery. METHODS We studied content validity, internal consistency, convergent validity (anxiety, depression and catastrophism) and test-retest reliability of the French version of the PSQ (PSQ-F) in 146 patients either before scheduled surgery or during pregnancy; then, convergent and concurrent validity in 85 healthy volunteers submitted to nociceptive tests. RESULTS Internal consistency of the PSQ-F was found to be excellent, with Cronbach's α at 0.866, 0.886, and 0.927, respectively for its "minor", "moderate" and "total" scores. Test-retest reliability was significant, with intraclass correlation coefficients at 0.629, 0.629, and 0.635, respectively for the above- mentioned scores. These three scores correlated with anxiety, depression and catastrophizing scores in patients, but not in healthy volunteers, possibly because of low and few variant psychometric scores in this group. They were inversely correlated to the temperature needed to evoke heat pain rated 6 out of 10, but not to the mechanical pain threshold (electronic von Frey), nor to the heat pain threshold. Finally, they directly correlated to the pain induced by the cold pressor test (minor and total scores only). DISCUSSION This validated version can now be used by French-speaking researchers and physicians. TRIAL REGISTRATION www.ClinicalTrials.gov (NCT03113903); 14 April, 2017.
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21
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Patel DV, Bawa MS, Haws BE, Khechen B, Block AM, Karmarkar SS, Lamoutte EH, Singh K. PROMIS Physical Function for prediction of postoperative pain, narcotics consumption, and patient-reported outcomes following minimally invasive transforaminal lumbar interbody fusion. J Neurosurg Spine 2019; 30:476-482. [PMID: 30717042 DOI: 10.3171/2018.9.spine18863] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/26/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study aimed to determine if the preoperative Patient-Reported Outcomes Measurement Information System, Physical Function (PROMIS PF) score is predictive of immediate postoperative patient pain and narcotics consumption or long-term patient-reported outcomes (PROs) following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). METHODS A prospectively maintained database was retrospectively reviewed. Patients who underwent primary, single-level MIS TLIF for degenerative pathology were identified and grouped by their preoperative PROMIS PF scores: mild disability (score 40-50), moderate disability (score 30-39.9), and severe disability (score 20-29.9). Postoperative pain was quantified using the visual analog scale (VAS), and narcotics consumption was quantified using Oral Morphine Equivalents. PROMIS PF, Oswestry Disability Index (ODI), 12-Item Short-Form Health Survey, Physical Component Summary (SF-12 PCS), and VAS back and leg pain were collected preoperatively and at 6-week, 3-month, 6-month, and 12-month follow-up. Preoperative PROMIS PF subgroups were tested for an association with demographic and perioperative characteristics using 1-way ANOVA or chi-square analysis. Preoperative PROMIS PF subgroups were tested for an association with immediate postoperative pain and narcotics consumption in addition to improvements in PROMIS PF, ODI, SF-12 PCS, and VAS back and leg pain by using linear regression controlling for statistically different demographic characteristics. RESULTS A total of 130 patients were included in this analysis. Patients were grouped by their preoperative PROMIS PF scores: 15.4% had mild disability, 63.8% had moderate disability, and 20.8% had severe disability. There were no significant differences among the subgroups in terms of age, sex, smoking status, and comorbidity burden. Patients with greater disability were more likely to be obese and to have workers' compensation insurance. There were no differences among subgroups in regard to operative levels, operative time, estimated blood loss, and hospital length of stay. Patients with greater disability reported higher VAS pain scores and narcotics consumption for postoperative day 0 and postoperative day 1. Patients with greater preoperative disability demonstrated lower PROMIS PF, ODI, SF-12 PCS, and worse VAS pain scores at each postoperative time point. CONCLUSIONS Patients with worse preoperative disability, as assessed by PROMIS PF, experienced increased pain and narcotics consumption, along with less improvement in long-term PROs. The authors conclude that PROMIS PF is an efficient and accurate instrument that can quickly assess patient disability in the preoperative period and predict both short-term and long-term surgical outcomes.
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Amir R, Leiba R, Eisenberg E. Anchoring the Numeric Pain Scale Changes Pain Intensity Reports in Patients With Chronic But Not With Acute Pain. Pain Pract 2018; 19:283-288. [PMID: 30328678 DOI: 10.1111/papr.12738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/10/2018] [Accepted: 10/09/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Despite enormous differences between acute and chronic pain, the numeric pain scale (NRS) is commonly used in pain research and clinical practice for assessing the intensity of both acute and chronic pain. The use of this scale has been challenged as it may fail to accurately reflect the pure intensity of chronic pain. AIM To compare the effect of anchoring the NRS on the intensity of pain reported by patients with acute vs. chronic pain. METHODS Patients with acute postoperative or chronic pain (n = 100/group) were requested to rate their: current clinical pain intensity on an NRS from 0 to 100; the intensity of an anchoring pain event on the same scale; and subsequently to rate again their current pain intensity while making reference to the reported intensity of the pain event. The magnitude of correction was compared between the 2 groups. RESULTS The anchoring pain was rated identically between the groups. However, following anchoring, patients with chronic pain made a significantly larger correction of their pain intensity than did those with acute pain (mean ± standard deviation = 9 ± 9, median [interquartile range] = 10 [0 to 10] vs. 3 ± 7, 0 [0 to 5], respectively; P < 0.0001). More patients in the chronic pain group corrected their pain intensity. Logistic regression showed that chronic pain and female gender significantly increased the likelihood of making the correction (chronic pain: odds ratio 7.2, 95% confidence interval 3.5 to 15.1, P < 0.0001; female gender: odds ratio 2.8, 95% confidence interval 1.4 to 5.5, P < 0.0001). CONCLUSION The results suggest that anchoring the NRS can potentially improve the accuracy of reported chronic pain intensity.
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Affiliation(s)
- Renana Amir
- Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Ronit Leiba
- Department of Statistics, Rambam Health Care Campus, Haifa, Israel
| | - Elon Eisenberg
- Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Pain Relief Unit, Rambam Health Care Campus, Haifa, Israel
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Shen F, Kim HJ, Lee NK, Chun HJ, Chang BS, Lee CK, Yeom JS. The influence of hand grip strength on surgical outcomes after surgery for degenerative lumbar spinal stenosis: a preliminary result. Spine J 2018; 18:2018-2024. [PMID: 29679727 DOI: 10.1016/j.spinee.2018.04.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/23/2018] [Accepted: 04/09/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although a number of prognostic factors have been demonstrated to be associated with surgical outcome of degenerative lumbar spinal stenosis (DLSS), no study has investigated the relation between hand grip strength (HGS) and treatment outcome of DLSS. PURPOSE The purpose of the present study was to examine the influence of HGS on surgical outcomes after surgery for patients with DLSS. STUDY DESIGN This is an observational study. PATIENT SAMPLE Patients who underwent spine surgery for DLSS were included in the study. OUTCOME MEASURES Oswestry Disability Index (ODI), EuroQOL (EQ-5D), and visual analog scale (VAS) scores for back or leg pain were assessed. MATERIALS AND METHODS A total of 172 consecutive patients who underwent spine surgery for DLSS were included in the present study. Patients were assigned to either high HGS group (≥26 kg for men and ≥18 kg for women, n=124) or low HGS group (<26 kg for men and <18 kg for women, n=48) based on their preoperative HGS performance. Oswestry Disability Index, EQ-5D, and VAS scores for back and leg pain were assessed and compared between two groups preoperatively, 3 and 6 months after surgery. The primary outcome measure was baseline-adjusted ODI scores 6 months after surgery. The secondary outcome measures, including the overall ODI score, EQ-5D score, VAS score for back and leg pain, were assessed at each time point during the 6-month follow-up period. RESULTS As primary outcome, baseline-adjusted ODI scores were significantly lower in the high HGS group than in the low HGS group 6 months after surgery. In the secondary outcome measurements, the ODI, EQ-5D, and VAS scores for back and leg pain improved significantly with time after surgery in both groups. The effects of HGS group on the overall changes in the ODI and EQ-5D scores during the 6-month period were significantly different between the two groups; however, they were not significantly different on VAS score for back and leg pain. The pattern of change in the ODI during the follow-up period was significantly different between the two groups. CONCLUSIONS Patients with preoperative high HGS display better surgical outcome in terms of disability and health status 6 months after spine surgery. Preoperative HGS can act as a predictor of surgical outcome in patients with DLSS.
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Affiliation(s)
- Feng Shen
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea.
| | - Na-Kyoung Lee
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea
| | - Heoung-Jae Chun
- Department of Mechanical Engineering, Yonsei University, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Bong-Soon Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea
| | - Choon-Ki Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam 463-707, Republic of Korea
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Elsayed GA, Dupépé EB, Erwood MS, Davis MC, McClugage SG, Szerlip P, Walters BC, Hadley MN. Education level as a prognostic indicator at 12 months following decompression surgery for symptomatic lumbar spinal stenosis. J Neurosurg Spine 2018; 30:60-68. [PMID: 30497217 DOI: 10.3171/2018.6.spine18226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/04/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe goal of this study was to analyze the effect of patient education level on functional outcomes following decompression surgery for symptomatic lumbar spinal stenosis.METHODSPatients with surgically decompressed symptomatic lumbar stenosis were collected in a prospective observational registry at a single institution between 2012 and 2014. Patient education level was compared to surgical outcomes to elucidate any relationships. Outcomes were defined using the Oswestry Disability Index score, back and leg pain visual analog scale (VAS) score, and the EuroQol-5 Dimensions questionnaire score.RESULTSOf 101 patients with symptomatic lumbar spinal stenosis, 27 had no college education and 74 had a college education (i.e., 2-year, 4-year, or postgraduate degree). Preoperatively, patients with no college education had statistically significantly greater back and leg pain VAS scores when compared to patients with a college education. However, there was no statistically significant difference in quality of life or disability between those with no college education and those with a college education. Postoperatively, patients in both cohorts improved in all 4 patient-reported outcomes at 3 and 12 months after treatment for symptomatic lumbar spinal stenosis.CONCLUSIONSDespite their education level, both cohorts showed improvement in their functional outcomes at 3 and 12 months after decompression surgery for symptomatic lumbar spinal stenosis.
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Affiliation(s)
- Galal A Elsayed
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Esther B Dupépé
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Matthew S Erwood
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Matthew C Davis
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Samuel G McClugage
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Paul Szerlip
- 2Department of Computer Science,University of Central Florida, Orlando, Florida
| | - Beverly C Walters
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
| | - Mark N Hadley
- 1Department of Neurosurgery, University of Alabama at Birmingham, Alabama; and
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Bjørnnes AK, Lie I, Parry M, Falk R, Leegaard M, Rustøen T, Valeberg BT. Association between self-perceived pain sensitivity and pain intensity after cardiac surgery. J Pain Res 2018; 11:1425-1432. [PMID: 30122973 PMCID: PMC6078187 DOI: 10.2147/jpr.s167524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and purpose Cardiac surgical pain remains a clinical challenge affecting about 40% of individuals in the first six months post-cardiac surgery, and continues up to two years after surgery for about 15–20%. Self-perceived sensitivity to pain may help to identify individuals at risk for persistent cardiac surgical pain to optimize health care responses. The purpose of this study was to assess the relationship between self-perceived pain sensitivity assessed by the Pain Sensitivity Questionnaire (PSQ) and postoperative worst pain intensity up to 12 months after cardiac surgery. Sex differences in baseline characteristics and the PSQ scores were also assessed. Methods This study was performed among 416 individuals (23% women) scheduled for elective coronary artery bypass graft and/or valve surgery between March 2012 and September 2013. A secondary data-analysis was utilized to explore the relationship between preoperative PSQ scores and worst pain intensity rated preoperatively, across postoperative Days 1–4, at 2 weeks, and at 1, 3, 6, and 12 months post-surgery. Linear mixed model analyses were performed to estimate changes in pain intensity during 1-year follow-up. Results The mean (±standard deviation) PSQ-total score was 3.3±1.4, with similar scores in men and women. The PSQ-total score was significantly associated with higher worst pain intensity ratings adjusted for participant characteristics (p=0.001). Conclusion Use of the PSQ before surgery may predict cardiac surgical pain intensity. However, previous evidence is limited and not consistent, and more research is needed to substantiate our results.
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Affiliation(s)
- Ann Kristin Bjørnnes
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway, .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada,
| | - Irene Lie
- Center for Patient Centered Heart and Lung Research, Department of Cardiothoracic Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada,
| | - Ragnhild Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Marit Leegaard
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Institute of Nursing, Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway, .,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Berit Taraldsen Valeberg
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Institute of Nursing, Oslo, Norway
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Patients' Experiences of Pain Have an Impact on Their Pain Management Attitudes and Strategies. Pain Manag Nurs 2018; 19:464-473. [PMID: 29776871 DOI: 10.1016/j.pmn.2018.02.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 01/13/2018] [Accepted: 02/17/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Postoperative pain remains undermanaged in orthopedic surgery. To identify areas of improvement for future structural changes in pain management, patients' experiences of pain and pain management when undergoing elective lumbar spine surgery were explored, using a qualitative method with focus group interviews. SETTING The study setting was an orthopedic spine surgery department at a University Hospital in Sweden. METHODS This study consisted of two focus group interviews with patients (n = 6/group, a total of 12 patients) who had undergone lumbar spine surgery 4 days to 5 weeks prior to the focus group interviews. The interviews were semi-structured, and the analysis was performed using qualitative content analysis. RESULTS The main result of this study revealed that patients' experiences of pain influenced their attitudes and strategies for pain management. Three main categories emerged from the focus group interviews: I. Coping with pain while waiting for surgery; II. Using different pain-relieving strategies after surgery; and III. How organizational structures influence the pain experiences. CONCLUSIONS In conclusion the results from this study acknowledge that postoperative pain experiences and coping strategies after spine surgery are highly diverse and individual. This calls for staff having a more personalized approach to pain management in order to optimize pain relief, which was stressed as highly valued by the patients.
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27
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Barikroo A, Carnaby G, Bolser D, Rozensky R, Crary M. Transcutaneous electrical stimulation on the anterior neck region: The impact of pulse duration and frequency on maximum amplitude tolerance and perceived discomfort. J Oral Rehabil 2018; 45:436-441. [PMID: 29574920 DOI: 10.1111/joor.12625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
Abstract
Maximum amplitude tolerance (MAT) has been known as a primary factor determining the depth of electrical current penetration. However, the effect of varying transcutaneous electrical stimulation (TES) parameters on MAT and discomfort level is poorly understood. Furthermore, limited information exists regarding the biopsychological factors that may impact MAT and discomfort. The primary aims of this study were to compare the effects TES protocol with varying levels of pulse duration (300 μs vs 700 μs) and frequency (30 Hz vs 80 Hz) on the MAT and discomfort in healthy older adults. The exploratory aim of this study was to examine relationships between submental adipose tissue thickness, pain sensitivity and gender with MAT and discomfort. Twenty-four healthy older adults participated in this study. Transcutaneous electrical stimulation was delivered to the submental region. Maximum amplitude tolerance and discomfort were measured for each condition. Furthermore, submental adipose tissue thickness and pain sensitivity were measured for each subject. Maximum amplitude tolerance was significantly increased for the TES protocols with short-pulse duration [F (3, 69) = 38.695, P < .0001]. Discomfort was similar across different TES protocols. Submental adipose tissue thickness (r = .30, P < .003) and pain sensitivity (r = -.43, P < .0001) were related to MAT. Pain sensitivity rating was also related to discomfort (r = .45, P < .0001). In conclusion, using TES protocols with short-pulse duration may increase the MAT. Higher amplitude stimulation may increase the impact on deep swallowing muscles. In addition, submental adipose tissue thickness and pain sensitivity are potential biopsychological factors that may affect MAT and discomfort.
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Affiliation(s)
- Ali Barikroo
- Swallowing Physiology and Rehabilitation Research Laboratory, Department of Speech Pathology and Audiology, Kent State University, Kent, OH, USA
| | - Giselle Carnaby
- Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA
| | - Donald Bolser
- Department of Physiological Sciences, University of Florida, Gainesville, FL, USA
| | - Ronald Rozensky
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael Crary
- Swallowing Research Laboratory, Department of Communication Sciences and Disorders, University of Central Florida, Orlando, FL, USA
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Meiselles D, Aviram J, Suzan E, Pud D, Eisenberg E. Does self-perception of sensitivity to pain correlate with actual sensitivity to experimental pain? J Pain Res 2017; 10:2657-2663. [PMID: 29180892 PMCID: PMC5691952 DOI: 10.2147/jpr.s149663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background People often state that they are “sensitive” or “insensitive” to pain. However, the accuracy and clinical relevance of such statements is unclear. Objective The aim of this study was to search for associations between self-perception of sensitivity to pain and experimental pain measures, including known psychophysical inhibitory or excitatory pain paradigms. Subjects and methods Subjective sensitivity to pain was reported by 75 healthy participants and included three self-perceived variables: pain threshold, pain sensitivity and pain intensity in response to a hypothetical painful event (hypothetical pain intensity [HPI]). Experimental pain measures consisted of thermal pain threshold (°C), suprathreshold thermal pain intensity (Visual Analog Scale, 0–100) and the psychophysical paradigms of conditioned pain modulation (CPM) and temporal summation (TS), representing inhibitory and excitatory pain processes, respectively. Results No significant correlations were found between self-perceived pain threshold or pain sensitivity and any of the experimental pain measures. In contrast, the reported HPI correlated with thermal pain threshold (r = −0.282; p = 0.014), suprathreshold thermal pain intensity (r = 0.367; p = 0.001) and CPM (r = 0.233; p = 0.044), but not with TS. Conclusion Self-perception of pain sensitivity articulated by intangible expressions such as pain threshold or pain sensitivity is unrelated to actual sensitivity to experimental pain. In contrast, when measured by intensity of a hypothetical painful event (HPI), sensitivity to pain is associated with some, but not all, experimental pain reports. Further studies are needed for better understanding of these associations and their potential clinical significance.
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Affiliation(s)
- Doron Meiselles
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology
| | - Joshua Aviram
- Faculty of Social Welfare and Health Sciences, University of Haifa
| | - Erica Suzan
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology
| | - Dorit Pud
- Faculty of Social Welfare and Health Sciences, University of Haifa
| | - Elon Eisenberg
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology.,Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel
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29
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Quan X, Fong DYT, Leung AYM, Liao Q, Ruscheweyh R, Chau PH. Validation of the Mandarin Chinese Version of the Pain Sensitivity Questionnaire. Pain Pract 2017; 18:180-193. [PMID: 28422444 DOI: 10.1111/papr.12587] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/12/2017] [Accepted: 03/09/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM The Pain Sensitivity Questionnaire (PSQ), a self-reported scale, has been used to assess the pain sensitivity level in a Caucasian population. However, a validated Mandarin Chinese version of the PSQ is not available. This study was aimed to translate the PSQ into Mandarin Chinese (PSQ-C) and validate it to measure pain sensitivity among Chinese people. METHODS The English version of the PSQ has been translated into Mandarin Chinese (PSQ-C), according to the standard steps of cross-cultural adaptation of self-reported scales. Three of the 17 items were revised owing to cultural adaptation. The final version was validated on a population of 182 Chinese people in Changsha City, China, during October to December 2015. The participants underwent electrical experimental pain testing. The psychometric properties of the PSQ-C and its subscales were examined. RESULTS The Cronbach's alpha coefficients for the PSQ-C-total, PSQ-C-moderate, and PSQ-C-minor were 0.90, 0.86, and 0.81, respectively. Acceptable test-retest reliability, content validity, and construct validity were demonstrated. Concurrent validity was shown via significant positive correlations between PSQ-C scores and perceived pain intensity at pain threshold and during pain stimulation with a fixed intensity. Convergent validity was shown via significant positive correlations between Pain Catastrophizing Scale scores and PSQ-C scores. Known group validity was demonstrated via higher PSQ-C-total and PSQ-C-moderate scores among those with high neuroticism scores. These results indicate that the PSQ-C has reasonably good psychometric properties, similar to the original English and German versions. CONCLUSION The PSQ-C is a reliable and useful tool to assess pain sensitivity levels in a Chinese population.
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Affiliation(s)
- Xiaoli Quan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.,The First People's Hospital of Huaihua and University of South China, Huaihua City, China
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Qin Liao
- The Third Xiangya Hospital of Central South University, Changsha, China
| | - Ruth Ruscheweyh
- Department of Neurology, University of Munich, Munich, Germany
| | - Pui Hing Chau
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Valeberg BT, Pedersen LM, Girotto V, Christensen VL, Stubhaug A. Validation of the Norwegian Pain Sensitivity Questionnaire. J Pain Res 2017; 10:1137-1142. [PMID: 28553134 PMCID: PMC5439722 DOI: 10.2147/jpr.s129540] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background and purpose There is a large variation in people’s reactions to painful stimuli. Although some conditions are more painful, the variation between people is larger than the reaction to pain across conditions. Induced experimental pain is one way to assess some aspects of these differences in pain perception. Experimental nociceptive testing is time consuming and not always feasible in a clinical setting. In order to overcome the obstacles of assessing pain sensitivity using experimental stimulation, the Pain Sensitivity Questionnaire (PSQ) was developed. The purpose of this study is to validate the Norwegian version of the PSQ. Methods Construct validity was examined through an exploratory principal component factor analysis with varimax rotation. Internal consistency was measured by Cronbach’s alpha reliability for subscales and the total PSQ. As confounding variables such as age and gender may contribute to the experience of pain, a regression analysis was performed with demographic variables and PSQ scores as independent variables and the experimental measures of pain as the dependent variable. Results The factor analysis yielded at two factor solution, with an eigenvalue greater than one, explain 58% of the variance. Cronbach’s alpha for the PSQ was 0.92. In the regression analysis, only PSQ scores contributed to explain the experimental pain intensity and tolerance. Gender only influenced the experimental pain threshold, as men had statistically significant higher heat pain threshold than women. Conclusion This study shows that PSQ is a valid and reliable questionnaire and might be a promising instrument for assessing pain sensitivity in Norwegian clinical settings. Further studies are needed to examine whether the PSQ can be used in clinical settings to predict postoperative pain and the development of chronic pain.
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Affiliation(s)
- Berit Taraldsen Valeberg
- Department of Nursing and Health promotion, Oslo and Akershus University College of Applied Sciences
| | - Linda Margareth Pedersen
- Research and communication unit for musculoskeletal health (FORMI).,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Valentina Girotto
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine and Surgery, University of Turin, Turin, Italy
| | - Vivi Lycke Christensen
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital
| | - Audun Stubhaug
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Valeberg BT, Høvik LH, Gjeilo KH. Relationship between self-reported pain sensitivity and pain after total knee arthroplasty: a prospective study of 71 patients 8 weeks after a standardized fast-track program. J Pain Res 2016; 9:625-9. [PMID: 27660489 PMCID: PMC5019430 DOI: 10.2147/jpr.s113258] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and purpose This was a prospective cohort study assessing data from 71 adult patients undergoing total knee arthroplasty (TKA) following a standardized fast-track program between January and July 2013. The objective was to examine the relationship between self-rated pain sensitivity, as measured by the Pain Sensitivity Questionnaire (PSQ), and postoperative pain after TKA. Methods The baseline questionnaires, PSQ and Brief Pain Inventory, were given to the patients for self-administration at the presurgical evaluation (1–2 weeks prior to surgery). The follow-up questionnaire, Brief Pain Inventory, was administered at the first follow-up, 8 weeks after surgery. Results A statistically significant association was found between average preoperative pain and average pain 8 weeks after surgery (P=0.001). The PSQ-minor was statistically significantly associated with average pain only for patients younger than 70 years (P=0.03). Interpretation This is the first study to examine the relationship between pain sensitivity measured by PSQ and postoperative pain in patients after TKA. We found that a lower score on the PSQ-minor was statistically significantly associated with patients’ pain 8 weeks after TKA surgery, but only for younger patients. Further research is needed to explore whether the PSQ could be a useful screening tool for patients’ pain sensitivity in clinical settings.
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Affiliation(s)
- Berit T Valeberg
- Faculty of Nursing, Oslo and Akershus University College of Applied Sciences, Oslo
| | - Lise H Høvik
- Clinic of Anaesthesia and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital
| | - Kari H Gjeilo
- Department of Cardiothoracic Surgery; Department of Cardiology; National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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32
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Azimi P, Benzel EC. Cut-Off Value for Pain Sensitivity Questionnaire in Predicting Surgical Success in Patients with Lumbar Disc Herniation. PLoS One 2016; 11:e0160541. [PMID: 27494617 PMCID: PMC4975474 DOI: 10.1371/journal.pone.0160541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 07/21/2016] [Indexed: 12/19/2022] Open
Abstract
Various factors related to predict surgical success were studied; however, a standard cut-off point for the Pain Sensitivity Questionnaire (PSQ) measure has not yet been established for a favorable surgical outcome for lumbar disc herniation (LDH). This study was to find the optimal cut-off point on the PSQ to distinguish surgical success in patients with LDH. A total of 154 patients with LDH consecutively referred to our clinic were enrolled into this prospective study between February 2011 and January 2014. All participants completed the PSQ. Patients completed the Oswestry Disability Index (ODI) score before surgery, and at 2 years after surgery. Surgical success was defined as a 13-point improvement from the baseline ODI scores. The cut-off value for PSQ was determined by the receiver-operating characteristic curve (ROC). The mean age of patients was 49.3±9.6 years, and there were 80 women. The mean time for follow-up assessment was 31±5 months (range 24–35). Post-surgical success was 79.9% (n = 123) at 2 years follow up. The mean score for the total PSQ, PSQ-minor, and PSQ-moderate were 6.0 (SD = 1.6), 5.4 (SD = 1.9) and 6.5 (SD = 1.7), respectively. Total PSQ score was also significantly correlated with the total scores of the ODI. The optimal total PSQ cut-off point was determined as > 5.2 to predict surgical success in LDH patients, with 80.0% sensitivity and 75.6% specificity (AUC-0.814, 95% CI 0.703–0.926). This study showed that the PSQ could be considered a parameter for predicting surgical success in patients with LDH, and can be useful in clinical practice.
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Affiliation(s)
- Parisa Azimi
- Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Edward C. Benzel
- Cleveland Clinic Foundation, Department of Neurosurgery, Cleveland, Ohio, United States of America
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Outcome Measure of Pain in Patients with Lumbar Disc Herniation: Validation Study of the Iranian version of Pain Sensitivity Questionnaire. Asian Spine J 2016; 10:480-7. [PMID: 27340527 PMCID: PMC4917766 DOI: 10.4184/asj.2016.10.3.480] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022] Open
Abstract
Study Design Cross-sectional. Purpose To translate and culturally adapt an Iranian version of the Pain Sensitivity Questionnaire (PSQ) in Iran. Overview of Literature Instruments measuring patient reported outcomes should satisfy certain psychometric properties. Methods The PSQ was translated following cross-cultural adaptation guidelines. A total of 101 patients with lumbar disc herniation (LDH), and 39 healthy cases were included in the study. All participants completed the PSQ and the Pain Catastrophizing Scale (PCS). The internal consistency, test-retest reliability, known group comparison, criterion validity and item-scale correlations were assessed. Results The mean age of participants was 51.7 years. Reliability, validity and correlation of PSQ and PCS showed satisfactory results. Cronbach's alpha coefficients were 0.81 for PSQ-total, 0.82 for PSQ-minor, and 0.82 for PSQ-moderate. The intraclass correlation coefficients value was 0.84 (0.616–0.932) indicating an excellent test-retest reliability. The instrument discriminated well between sub-groups of patients who differed in a standard predictive measure of LDH surgery (the Finneson–Cooper score). Total PSQ were also significantly correlated with the total scores of the PCS, lending support to its good convergent validity. Additionally, the correlation of each item with its hypothesized domain on the PSQ indicated acceptable results, suggesting that the items had a substantial relationship with their own domains. Conclusions The adapted Iranian PSQ is a valid and reliable questionnaire for the assessment of pain in patients with LDH.
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Determination of the Optimal Cutoff Values for Pain Sensitivity Questionnaire Scores and the Oswestry Disability Index for Favorable Surgical Outcomes in Subjects With Lumbar Spinal Stenosis. Spine (Phila Pa 1976) 2015; 40:E1110-6. [PMID: 26076437 DOI: 10.1097/brs.0000000000001023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected data (NCT02134821). OBJECTIVE The aim of this study was to elucidate the cutoff values for significant predictors for favorable outcomes after lumbar spine surgery in patients with lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA Various factors are associated with the surgical outcomes for patients with LSS. However, we did not know the odds ratio and/or cutoff values of a predictive factor for a favorable surgical outcome for LSS. METHODS A total of 157 patients who underwent spine surgery due to LSS between June 2012 and April 2013 were included in this study. The patients were dichotomized into 2 groups on the basis of an Oswestry Disability Index (ODI) score of 22 or less (favorable outcome group) or more than 22 (unfavorable outcome group) at 12 months after surgery. Regarding favorable outcomes, the odds ratio for each preoperative variable including demographic data, preoperative symptom severity, and pain sensitivity questionnaire (PSQ) score was calculated using univariate and multivariate logistic regression analyses. For the significant variables for surgical outcome, receiver operating characteristic (ROC) curve was plotted with calculation of the area under the ROC curve. RESULTS Multivariate analysis revealed that the ODI and total PSQ scores were significantly associated with a greater likelihood of an unfavorable surgical outcome [odds ratio (95% confidence interval) of ODI, 1.289 (1.028-1.616); odds ratio (95% confidence interval) of total PSQ, 1.060 (1.009-1.113)]. ROC analysis revealed area under the ROC curves for the total PSQ and ODI scores of 0.638 (P = 0.005) and 0.692 (P < 0.001), respectively. CONCLUSION Preoperative disability and pain sensitivity can be predictors of the functional level achieved after spine surgery in patients with LSS, and the ideal cutoff values for the total PSQ and ODI scores were 6.6 and 45.0, respectively.
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Coronado RA, George SZ, Devin CJ, Wegener ST, Archer KR. Pain Sensitivity and Pain Catastrophizing Are Associated With Persistent Pain and Disability After Lumbar Spine Surgery. Arch Phys Med Rehabil 2015; 96:1763-70. [PMID: 26101845 DOI: 10.1016/j.apmr.2015.06.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/10/2015] [Accepted: 06/13/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery. DESIGN Prospective observational cohort study. SETTING Academic medical center. PARTICIPANTS Patients (N=68; mean age, 57.9±13.1y; 40 women [58.8%]) undergoing spine surgery for a degenerative condition from March 1, 2012 to April 30, 2013 were assessed 6 weeks, 3 months, and 6 months after surgery. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥4 and Oswestry Disability Index scores ≥21 at all postoperative time points. RESULTS From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated with having persistent back pain intensity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.0-4.1) after surgery. Increased pain catastrophizing at 6 weeks was associated with having persistent back pain intensity (OR, 1.1; 95% CI, 1.0-1.2), pain interference (OR, 1.1; 95% CI, 1.0-1.2), and disability (OR, 1.3; 95% CI, 1.1-1.4). An interaction effect was not found between pain sensitivity and pain catastrophizing on persistent outcomes (P>.05). CONCLUSIONS The findings suggest the importance of early postoperative screening for pain sensitivity and pain catastrophizing to identify patients at risk for poor postoperative pain intensity, pain interference, and/or disability outcomes. Future research should consider the benefit of targeted therapeutic strategies for patients with these postoperative prognostic factors.
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Affiliation(s)
| | - Steven Z George
- Department of Physical Therapy, University of Florida, Gainesville, FL; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN
| | - Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN; Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN.
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