Authors: Yvonne Lindbäck Hans Tropp Paul Enthoven Björn Gerdle Allan Abbott Birgitta Öberg
Publish Date: 2017/02/06
Volume: 26, Issue: 10, Pages: 2581-2588
Abstract
This is a prospective cohort study with 82 patients Associations between pressure cold and heat pain threshold PPT CPT HPT in the hand presurgery and Oswestry VAS pain EQ5D HADS and SelfEfficacy Scale pre and three months postsurgery were investigated with linear regressionPatients with disc herniation more sensitive to pressure pain presurgery showed lower function and selfefficacy and higher anxiety and depression presurgery and lower function and selfefficacy and higher pain postsurgery Results for cold pain were similar In patients with spinal stenosis few associations with PROs were found and none for HPT and PROsLow back pain LBP is the condition causing most disability globally 1 Only about 10 of all LBP problems are represented by disc herniation or spinal stenosis but they represent the most common conditions in spinal surgery 2 3 In these groups the outcome is questioned since 20–35 is doubtful or dissatisfied with the results at oneyear followup 3 Challenges are to develop screening identifying those with increased risk of a poor prognosis and to select interventions based on prognostic factors for improvement of outcomes 2 4 Sociodemographic clinical workrelated and psychological risk factors may partly explain poor outcomes after spinal surgery 5 Another reported risk factor is insufficient pain treatment pre and postsurgery 6 It has been suggested that screening of somatosensory function may contribute to the understanding of pain mechanisms involved 7 Somatosensory profiles can be assessed with quantitative sensory testing QST by measuring amongst others pressure cold and heat pain thresholds PPT CPT and HPT Lowered pain thresholds in QST measurement is described as an indication for central hyperexcitability 8 This alteration in sensory thresholds can either be localized or widespread including a nonaffected body regions 9Thermal thresholds in an affected body region were normalized in patients with spinal degenerative disease who had recovered 6 months postsurgery while they were not normalized in patients with remaining pain postsurgery 10 Lowered PPT in nonaffected body regions was associated with higher presurgery and 12 months postsurgery pain severity but not with change in pain from presurgery to followup after hip or knee replacement 11 A previous analysis of the present cohort of patients with degenerative lumbar spine disorders selected for surgery showed that an altered sensory profile in both affected and nonaffected body regions presurgery were associated with higher back and leg pain intensity and lower mental health presurgery Lindbäck Y et al submitted manuscript 2016 However prospective studies are needed to further examine whether these dimensions can be useful as a screening tool for outcome postsurgery The purpose was to investigate the association between pain sensitivity in the hand presurgery and patientreported outcomes PROs in function pain and health pre and postsurgery in patients with disc herniation or spinal stenosis Our hypothesis was that patients more sensitive to pain in the hand a sign of widespread altered pain response will have higher pain lower function and health pre and postsurgeryThis is a prospective cohort study The study conforms to the STROBE statement checklist The study was approved by the Regional Ethics committee Dnr 2013/41031 The patients received oral and written information about the study and they all signed an informed consent before the measurement Fortyseven patients 57 were even included in Prepare a study investigating the effect of presurgery physiotherapy Clintrialsgov NCT02454400The patients were consecutively recruited at the University Spine Clinic Linkoping Sweden between September 2013 and December 2014 The somatosensory function was investigated with QST 1–2 weeks presurgery by one single investigator at the Spine Clinic The patients filled out PROs pre and 3 months postsurgery
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