Effect of the duration of chronic low back pain on pain sensitivity of patients undergoing lumbar fusion surgery
DOI:
https://doi.org/10.31636/pmjua.v5i4.2Keywords:
effect, duration of chronic low back pain, pain sensitivity, lumbar fusion surgeryAbstract
Background: chronic low back pain is a serious social problem. In recent years, patients who choose lumbar fusion surgery due to chronic low back pain has been increasing. Pre-existing chronic pain has been associated with severe postoperative pain. In this study, we have sought to prospectively analyze the association between the duration of chronic low back pain and pain sensitivity after lumbar fusion surgery.
Methods: 400 patients who underwent lumbar fusion surgery were divided into three groups based on the duration of chronic pain. During the first postoperative day, the maximum pain scores of each patient day and night, the pain scores at the day of discharge, the consumption of postoperative analgesics and the length of hospital stay were recorded.
Results: of 400 patients recruited, 369 patients completed the experiment. There was no significant difference in gender, age, height, weight, pre-operative pain at rest, and operation time in the three groups. During the day, the pain sensitivity of the three groups were 1.71 ± 0.66, 2.40 ± 0.74, 2.90 ± 0.80. During the night, the pain sensitivity of the three groups were 3.45 ± 0.81, 4.31 ± 1.06, 4.86 ± 1.05. At the day of discharge, the pain sensitivity of three groups were 1.26 ± 0.46, 1.47 ± 0.58, 1.96 ± 0.64. There were significant differences in pain sensitivity among the three groups during the day and night on the first postoperative day and at the day of discharge (p < 0.05). The length of hospital stay (7.31 ± 1.36 days, 8.82 ± 1.48 days, 9.60 ± 1.61 days) and analgesic consumption (25.04 ± 36.56 mg, 33.52 ± 24.04 mg, 45.15 ± 24.89 mg, morphine equivalent) were also significant differences (p < 0.05).
Conclusion: we found the duration of chronic low back pain before lumbar fusion surgery affects patient’ postoperative pain sensitivity, consumption of analgesic drugs and hospital stay. The longer the preoperative chronic pain lasts, the higher the postoperative VAS score is, the more analgesic drugs were consumed, and the longer hospital stay is.
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References
Fairbank JCT, Pynsent PB. The Oswestry Disability Index. Spine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2000 Nov;25(22):2940–53. Available from: https://doi.org/10.1097/00007632-200011150-00017
Ko S, Chae S. Correlations Between the SF-36, the Oswestry-Disability Index and Rolland-Morris Disability Questionnaire in Patients Undergoing Lumbar Decompression According to Types of Spine Origin Pain. Clinical Spine Surgery [Internet]. Ovid Technologies (Wolters Kluwer Health); 2017 Jul;30(6):E804–E808. Available from: https://doi.org/10.1097/bsd.0000000000000438
Ehrlich GE. Low back pain. Bull World Health Organ. 2003;81(9):671-6.
VanDenKerkhof EG, Peters ML, Bruce J. Chronic pain after surgery: time for standardization? A framework to establish core risk factor and outcome domains for epidemiological studies. The Clinical journal of pain. 2013 Jan 1;29(1):2-8.
Weiss AJ, Elixhauser A, Andrews RM. Characteristics of operating room procedures in US hospitals, 2011: statistical brief# 170.
Strömqvist B, Fritzell P, Hägg O, Jönsson B, Sandén B. Swespine: the Swedish spine register. European Spine Journal [Internet]. Springer Science and Business Media LLC; 2013 Apr;22(4):953–74. Available from: https://doi.org/10.1007/s00586-013-2758-9
Försth P, Ólafsson G, Carlsson T, Frost A, Borgström F, Fritzell P, et al. A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2016 Apr 14;374(15):1413–23. Available from: https://doi.org/10.1056/nejmoa1513721
Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States, 2004 to 2015. SPINE [Internet]. Ovid Technologies (Wolters Kluwer Health); 2019 Mar;44(5):369–76. Available from: https://doi.org/10.1097/brs.0000000000002822
Lotzke H, Jakobsson M, Brisby H, Gutke A, Hägg O, Smeets R, den Hollander M, Olsson LE, Lundberg M. Use of the PREPARE (PREhabilitation, Physical Activity and exeRcisE) program to improve outcomes after lumbar fusion surgery for severe low back pain: a study protocol of a person-centred randomised controlled trial. BMC Musculoskeletal Disorders. 2016 Dec;17(1):1-3.
Maheshwari K, Avitsian R, Sessler DI, Makarova N, Tanios M, Raza S, et al. Multimodal Analgesic Regimen for Spine Surgery. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2020 May 1;132(5):992–1002. Available from: https://doi.org/10.1097/aln.0000000000003143
Tan M, Law LS-C, Gan TJ. Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways. Canadian Journal of Anesthesia/Journal canadien d’anesthésie [Internet]. Springer Science and Business Media LLC; 2014 Dec 10;62(2):203–18. Available from: https://doi.org/10.1007/s12630-014-0275-x
Wise EA, Price DD, Myers CD, Heft MW, Robinson ME. Gender role expectations of pain: relationship to experimental pain perception. Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2002 Apr;96(3):335–42. Available from: https://doi.org/10.1016/s0304-3959(01)00473-0
Majchrzak M, Brzecka A, Daroszewski C, Błasiak P, Rzechonek A, Tarasov VV, et al. Increased Pain Sensitivity in Obese Patients After Lung Cancer Surgery. Frontiers in Pharmacology [Internet]. Frontiers Media SA; 2019 Jun 14;10. Available from: https://doi.org/10.3389/fphar.2019.00626
Jain N, Phillips F M, Weaver T, et al. Preoperative Chronic Opioid Therapy: A Risk Factor for Complications, Readmission, Continued Opioid Use and Increased Costs After One- and Two-Level Posterior Lumbar Fusion[J]. Spine, 2018,43(19):1.
Thomazeau J, Rouquette A, Martinez V, Rabuel C, Prince N, Laplanche JL, et al. Acute pain Factors predictive of post-operative pain and opioid requirement in multimodal analgesia following knee replacement. European Journal of Pain [Internet]. Wiley; 2015 Oct 30;20(5):822–32. Available from: https://doi.org/10.1002/ejp.808
Boyle JK, Anthony IC, Jones BG, Wheelwright EF, Blyth MJG. Influence of low back pain on total knee arthroplasty outcome. The Knee [Internet]. Elsevier BV; 2014 Mar;21(2):410–4. Available from: https://doi.org/10.1016/j.knee.2013.12.003
Erlenwein J, Thoms K-M, Brandebusemeyer F, Pfingsten M, Mansur A, Quintel M, et al. Pre-Existing Chronic Pain Influences the Severity of Acute Herpes Zoster Pain—A Prospective Observational Cohort Study. Pain Medicine [Internet]. Oxford University Press (OUP); 2016 Mar 5;17(7):1317–28. Available from: https://doi.org/10.1093/pm/pnv116
Erlenwein J, Przemeck M, Degenhart A, Budde S, Falla D, Quintel M, et al. The Influence of Chronic Pain on Postoperative Pain and Function After Hip Surgery: A Prospective Observational Cohort Study. The Journal of Pain [Internet]. Elsevier BV; 2016 Feb;17(2):236–47. Available from: https://doi.org/10.1016/j.jpain.2015.10.013
Andersen LO, Gaarn-Larsen L, Kristensen BB, Husted H, Otte KS, Kehlet H. Subacute pain and function after fast-track hip and knee arthroplasty. Anaesthesia [Internet]. Wiley; 2009 May;64(5):508–13. Available from: https://doi.org/10.1111/j.1365-2044.2008.05831.x
Kehlet H. Postoperative pain, analgesia, and recovery—bedfellows that cannot be ignored. PAIN [Internet]. Ovid Technologies (Wolters Kluwer Health); 2018 Sep;159:S11–S16. Available from: https://doi.org/10.1097/j.pain.0000000000001243
Azim S, Nicholson J, Rebecchi MJ, Galbavy W, Feng T, Reinsel R, et al. Endocannabinoids and acute pain after total knee arthroplasty. PAIN [Internet]. Ovid Technologies (Wolters Kluwer Health); 2015 Feb;156(2):341–7. Available from: https://doi.org/10.1097/01.j.pain.0000460315.80981.59
Gu H, Deng X, Lv Y, Chen Q, Yu W. Preoperational chronic pain impairs the attention ability before surgery and recovery of attention and memory abilities after surgery in non-elderly patients. Journal of Pain Research [Internet]. Informa UK Limited; 2018 Dec;Volume 12:151–8. Available from: https://doi.org/10.2147/jpr.s178118
Erlenwein J, Przemeck M, Degenhart A, Budde S, Falla D, Quintel M, et al. The Influence of Chronic Pain on Postoperative Pain and Function After Hip Surgery: A Prospective Observational Cohort Study. The Journal of Pain [Internet]. Elsevier BV; 2016 Feb;17(2):236–47. Available from: https://doi.org/10.1016/j.jpain.2015.10.013
Meints SM, Mawla I, Napadow V, Kong J, Gerber J, Chan S-T, et al. The relationship between catastrophizing and altered pain sensitivity in patients with chronic low-back pain. PAIN [Internet]. Ovid Technologies (Wolters Kluwer Health); 2019 Apr;160(4):833–43. Available from: https://doi.org/10.1097/j.pain.0000000000001461
Alfieri FM, Lima ARS, Battistella LR, Silva NC de OV e. Superficial temperature and pain tolerance in patients with chronic low back pain. Journal of Bodywork and Movement Therapies [Internet]. Elsevier BV; 2019 Jul;23(3):583–7. Available from: https://doi.org/10.1016/j.jbmt.2019.05.001
Paul C. Willems P. Provocative diskography: safety and predictive value in the outcome of spinal fusion or pain intervention for chronic low-back pain. Journal of Pain Research [Internet]. Informa UK Limited; 2014 Dec;699. Available from: https://doi.org/10.2147/jpr.s45615
Kang JD, Stefanovic-Racic M, McIntyre LA, Georgescu HI, Evans CH. Toward a Biochemical Understanding of Human Intervertebral Disc Degeneration and Herniation. Spine [Internet]. Ovid Technologies (Wolters Kluwer Health); 1997 May;22(10):1065–73. Available from: https://doi.org/10.1097/00007632-199705150-00003
Kang JD, Georgescu HI, McIntyre-Larkin L, Stefanovic-Racic M, Evans CH. Herniated Cervical Intervertebral Discs Spontaneously Produce Matrix Metalloproteinases, Nitric Oxide, Interleukin-6, and Prostaglandin E2. Spine [Internet]. Ovid Technologies (Wolters Kluwer Health); 1995 Nov;20(Supplement):2373–8. Available from: https://doi.org/10.1097/00007632-199511001-00001
Jensen KB, Loitoile R, Kosek E, Petzke F, Carville S, Fransson P, Marcus H, Williams SC, Choy E, Mainguy Y, Vitton O. Patients with fibromyalgia display less functional connectivity in the brain's pain inhibitory network. Molecular pain. 2012 Apr 26;8:1744-8069.
Weisberg SP, McCann D, Desai M, Rosenbaum M, Leibel RL, Ferrante AW. Obesity is associated with macrophage accumulation in adipose tissue. Journal of Clinical Investigation [Internet]. American Society for Clinical Investigation; 2003 Dec 15;112(12):1796–808. Available from: https://doi.org/10.1172/jci200319246
Häuser W, Schmutzer G, Henningsen P, Brähler E. Chronische Schmerzen, Schmerzkrankheit und Zufriedenheit der Betroffenen mit der Schmerzbehandlung in Deutschland. Der Schmerz [Internet]. Springer Science and Business Media LLC; 2014 Sep 20;28(5):483–92. Available from: https://doi.org/10.1007/s00482-014-1438-y
Häuser W, Schmutzer G, Hilbert A, Brähler E, Henningsen P. Prevalence of Chronic Disabling Noncancer Pain and Associated Demographic and Medical Variables. The Clinical Journal of Pain [Internet]. Ovid Technologies (Wolters Kluwer Health); 2015 Oct;31(10):886–92. Available from: https://doi.org/10.1097/ajp.0000000000000173
Skeppholm M, Fransson R, Hammar M, Olerud C. The association between preoperative mental distress and patient-reported outcome measures in patients treated surgically for cervical radiculopathy. The Spine Journal [Internet]. Elsevier BV; 2017 Jun;17(6):790–8. Available from: https://doi.org/10.1016/j.spinee.2016.02.037
Thomazeau J, Rouquette A, Martinez V, Rabuel C, Prince N, Laplanche JL, et al. Acute pain Factors predictive of post-operative pain and opioid requirement in multimodal analgesia following knee replacement. European Journal of Pain [Internet]. Wiley; 2015 Oct 30;20(5):822–32. Available from: https://doi.org/10.1002/ejp.808
Stamenkovic DM, Rancic NK, Latas MB, Neskovic V, Rondovic GM, Wu JD, et al. Preoperative anxiety and implications on postoperative recovery: what can we do to change our history. Minerva Anestesiologica [Internet]. Edizioni Minerva Medica; 2018 Nov;84(11). Available from: https://doi.org/10.23736/s0375-9393.18.12520-x
Bair MJ, Wu J, Damush TM, Sutherland JM, Kroenke K. Association of Depression and Anxiety Alone and in Combination With Chronic Musculoskeletal Pain in Primary Care Patients. Psychosomatic Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2008 Oct;70(8):890–7. Available from: https://doi.org/10.1097/psy.0b013e318185c510
Meints SM, Mawla I, Napadow V, Kong J, Gerber J, Chan S-T, et al. The relationship between catastrophizing and altered pain sensitivity in patients with chronic low-back pain. PAIN [Internet]. Ovid Technologies (Wolters Kluwer Health); 2019 Apr;160(4):833–43. Available from: https://doi.org/10.1097/j.pain.0000000000001461
Nilsson U, Dahlberg K, Jaensson M. Low Preoperative Mental and Physical Health is Associated with Poorer Postoperative Recovery in Patients Undergoing Day Surgery: A Secondary Analysis from a Randomized Controlled Study. World Journal of Surgery [Internet]. Springer Science and Business Media LLC; 2019 Apr 1;43(8):1949–56. Available from: https://doi.org/10.1007/s00268-019-04995-z
Romain B, Rohmer O, Schimchowitsch S, Hübner M, Delhorme JB, Brigand C, et al. Influence of preoperative life satisfaction on recovery and outcomes after colorectal cancer surgery - a prospective pilot study. Health and Quality of Life Outcomes [Internet]. Springer Science and Business Media LLC; 2018 Jan 17;16(1). Available from: https://doi.org/10.1186/s12955-017-0824-4
Pincus T, Burton AK, Vogel S, Field AP. A Systematic Review of Psychological Factors as Predictors of Chronicity/Disability in Prospective Cohorts of Low Back Pain. Spine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2002 Mar;27(5):E109–E120. Available from: https://doi.org/10.1097/00007632-200203010-00017
Zhao S, Chen F, Wang D, Wang H, Han W, Zhang Y. Effect of preoperative smoking cessation on postoperative pain outcomes in elderly patients with high nicotine dependence. Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2019 Jan;98(3):e14209. Available from: https://doi.org/10.1097/md.0000000000014209
Vogt MT, Hanscom B, Lauerman WC, Kang JD. Influence of Smoking on the Health Status of Spinal Patients. Spine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2002 Feb;27(3):313–9. Available from: https://doi.org/10.1097/00007632-200202010-00022
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This work is licensed under a Creative Commons Attribution 4.0 International License