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Surgeons
should discuss and educate the patients about addressing pain-related
expectations prior to surgery.
The patients undergoing lumbar spine surgery expects pain
relief. This study was performed to investiagate the 2-year postoperative pain
and to determine whether this outcome varied as per the patient and clinical
characteristics, encompassing amount of pain relief expected preoperatively.
A total of 422 patients, before surgery patients completed
valid questionnaires that addressed clinical characteristics and expectations
for pain improvement. After two years of surgery, the patients explained how
much pain improvement they actually received.
Mean age was 56
years old and 55% were men. Out of these, 11% of patients reported no
improvement in pain, 28% reported a little to moderate improvement, 44%
reported a lot of improvement, and 17% reported complete improvement two years
after surgery.
The patients detailed less pain improvement if, before
surgery, they expected greater pain improvement (odds ratio [OR] 1.4), had a
positive screen for depression (OR 1.7), were having revision surgery (OR 1.6),
had surgery at L4 or L5 (OR 2.5), had a degenerative diagnosis (OR 1.6), and
if, after surgery, they had another surgery (OR 2.8) and greater back (OR 1.3)
and leg (OR 1.1) pain (all variables P≤0.05) in multivariable analysis.
Pain is common after lumbar surgery and is concerned with a
network of clinical, surgical, and psychological variables. The patients’
expectations about pain are an independent variable in this network as was
concluded from this study. This study supports addressing pain-related
expectations with patients before surgery via discussions with surgeons and
through formal preoperative patient education as the expectations are
potentially modifiable.
The Clinical Journal of Pain
Improvement in Pain After Lumbar Spine Surgery: The Role of Preoperative Expectations of Pain Relief
Mancuso et al.
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