Preoperative Pain Sensitivity may Predict Analgesics Requirement after Lumbar Fusion Surgery

The prospective, observational study included 60 patients who were scheduled for a single-level lumbar fusion surgery. The researchers Dr. Sachin P. Angadi and team of doctors at Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Road, Coimbatore, India measured preoperative pain sensitivity using objective methods such as pressure pain threshold measurements with a digital algometer and heat pain threshold using a neurotouch instrument. Pain sensitivity questionnaires were also used to gather additional information.

Psychosocial and functional assessments were performed using Hospital anxiety-depression scores (HADS) and the Oswestry disability index (ODI), respectively. Preoperative visual analog scale (VAS) scores were recorded at different instances, including needle pricks and lumbar spine movements. Postoperative VAS scores and breakthrough analgesic requirements were monitored from day 0 to day 3.

● The study involved a group of patients with an average age of 51.11 ± 13.467 years, and 70% of them were female. Interestingly, females exhibited lower mean algometry values (72.14±7.56) compared to males (77.34±6.33).

● The researchers found significant correlations between higher Hospital anxiety-depression scores (HADS), higher pain sensitivity questionnaire scores (PSQ), higher Oswestry disability index (ODI) scores, and female gender with lower algometer average scores, indicating heightened pain sensitivity.

● Patients with lower preoperative visual analog scale (VAS) scores and higher neurotouch scores experienced lower postoperative VAS scores at various time periods.

● The researchers considered preoperative VAS scores, algometer average scores, neurotouch scores, and HADS scores as independent variables for predicting

post-operative VAS scores at 6-hour intervals.

● Through multivariate analysis, they discovered that factors such as preoperative VAS scores, algometer average scores, and HADS scores were statistically significant (P<0.05) predictors.

● There was a noteworthy correlation between algometer average scores (p<0.001) and the need for breakthrough analgesics.

● This suggests that patients with higher algometer average scores, indicating greater pain sensitivity, required more frequent use of additional pain relief measures.

These findings emphasize the importance of preoperative assessments in predicting postoperative pain outcomes. Higher HADS and PSQ scores, along with elevated ODI scores and female gender, were associated with increased pain sensitivity. Conversely, lower preoperative VAS scores and higher neurotouch scores were linked to reduced postoperative pain severity.

Further research and validation of these findings could contribute to the development of personalized pain management protocols, ensuring that patients receive optimal care tailored to their specific needs. With a focus on preoperative pain sensitivity assessment, healthcare providers can strive to enhance the postoperative experience and improve patient satisfaction during the recovery process.

Reference:

Angadi, D. S. P., Ramachandran, D. K., Shetty, D. A. P., Kanna, D. R. M., & Shanmuganathan, R. (2023). Pre-operative pain sensitivity predicts post-operative pain severity and analgesics requirement in lumbar fusion surgery- A prospective observational study. The Spine Journal : Official Journal of the North American Spine Society.

https://doi.org/10.1016/j.spinee.2023.05.010