Search

OBJECTIVE: To explore whether preoperative pain intensity, pain cognitions, and quantitative sensory measures influence the established effectiveness of perioperative pain neuroscience education (PPNE) on health-related quality of life at 1 year after surgery for lumbar radiculopathy. DESIGN: Secondary analysis of a triple-blinded randomized controlled trial. METHODS: Participants (n = 90) were Dutch-speaking adults (18-65 years) who were scheduled for surgery for lumbar radiculopathy in 3 Belgian hospitals. They were randomized (1:1) to receive PPNE (n = 41) or perioperative biomedical education (n = 49). Linear mixed models were built for health-related quality of life (ie, SF-6D utility values, Physical and Mental Component of the 36-item Short Form Health Survey) using the following independent variables: therapy, time, and preoperative scores for back and leg pain intensity, pain catastrophizing, kinesiophobia, hypervigilance, and quantitative sensory measures. RESULTS: The impact of PPNE on SF-6D utility values over time was influenced by kinesiophobia (F = 3.30, P = .02) and leg pain intensity (F = 3.48, P = .02). Regardless of the intervention, back pain intensity negatively influenced SF-6D values over time (F = 3.99, P = .009). The Physical Component scores were negatively impacted by back pain intensity (F = 9.08, P = .003) and were influenced over time by leg pain intensity (F = 2.87, P = .04). The Mental Component scores were negatively impacted by back pain intensity (F = 6.64, P = .01) and pain catastrophizing (F = 5.42, P = .02), as well as hypervigilance (F = 3.16, P = .03) and leg pain intensity (F = 3.12, P = .03) over time. CONCLUSION: PPNE may be more effective than perioperative biomedical education in improving postoperative health utility values in patients who reported higher kinesiophobia and leg pain intensity before surgery for lumbar radiculopathy. J Orthop Sports Phys Ther 2024;54(4):1-10. Epub 8 January 2024. doi:10.2519/jospt.2024.12051 .

Introduction: Current perioperative education for patients undergoing lumbar surgery is only limited effective in preventing unfavorable outcome. Perioperative pain neuroscience education (PPNE) is a recently introduced intervention that aims to inform such patients about what to expect from their recovery, to improve maladaptive pain cognitions, and to reconceptualize pain. As such, this study aims to evaluate the effectiveness of PPNE on quality of life at 6 weeks post-surgery in at-risk patients undergoing surgery for lumbar radiculopathy. Methods: Following screening, 108 at-risk patients (i.e., having chronic pain = 6 months, and maladaptive degrees of kinesiophobia and pain catastrophizing) undergoing surgery for lumbar radiculopathy will be randomized into an experimental (PPNE) or control (perioperative biomedical education) group. Intervention includes a pre-and postoperative in-person session with a physiotherapist, and access to an educational web application. The primary outcome measure is quality of life which will be assessed at 1 week pre-surgery, and 6 weeks, 6 months and 1 year post-surgery. Results: The central hypothesis describes that due to the effect of PPNE these patients, despite their risk profile for unfavorable outcome, will have good surgical outcome with improvements in quality of life. Discussion: Findings will provide insight in the effectiveness of PPNE as a preventive measure for unfavorable surgical outcome and will be valuable for all clinicians working with such at-risk patients. Process evaluation: Though recruitment for this study has recently started, the process has been slow. As such, updated recruitment strategies are needed to help overcome current barriers. [ABSTRACT FROM AUTHOR]

Introduction: The benefits of perioperative pain neuroscience education (PPNE) for people undergoing surgery for lumbar radiculopathy have recently been established. 1,2 However so far, not much is known about which factors influence PPNE's treatment success. Therefore, this study aims to assess the potential influence of preoperative pain intensity, pain cognitions and sensory function on the PPNE treatment effect for postoperative quality of life 1 year following surgery for lumbar radiculopathy. Methods: This study is a secondary analysis of a randomized controlled trial in which 120 patients were randomized to receive either PPNE or perioperative biomedical education (PBE).3 Quality of life was assessed using the Short Form 36-item Health Survey (SF-36) at baseline (1 week pre-surgery), and 6 weeks, 6 months and 1 year post-surgery. Linear mixed models will be built for the SF-36 Physical component, SF-36 Mental component, and SF-6D utility scores using the following independent variables: treatment (PPNE versus PBE), time, and baseline scores for back pain intensity, leg pain intensity, pain catastrophizing, kinesiophobia, hypervigilance, and measures of quantitative sensory testing (i.e., electrical pain threshold, temporal summation, and conditioned pain modulation). Results: It is hypothesized that patients who report unfavorable scores for these preoperative factors will show a larger treatment effect of PPNE on postoperative quality of life. Discussion: Findings will provide novel insight into the potential moderating effect of preoperative factors on treatment outcome following PPNE in people undergoing surgery for lumbar radiculopathy. Process evaluation: Analysis for this study is underway and results are expected in Spring 2022. [ABSTRACT FROM AUTHOR]