Expecting pain improvement after the lumbar spine surgery

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Expecting pain improvement after the lumbar spine surgery

Pain is common after lumbar surgery and is concerned with a network of clinical, surgical and psychological variables. The improvement in pain/pain relief becomes a major expectation of the patients undergoing lumbar spine surgery. Mancuso et al.,  investigated the 2-year postoperative pain to determine whether this outcome varied as per the patient and clinical characteristics, encompassing the amount of pain relief expected preoperatively.

A total of 422 patients (mean age 56 years old and 55% men), 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 all the participants, 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 (p≤0.05) in multivariable analysis.

 It was concluded that the patient's expectations about pain are an independent variable in this network. This study supported 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

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The original title of the article:

Improvement in Pain After Lumbar Spine Surgery: The Role of Preoperative Expectations of Pain Relief


Mancuso et al.

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