S. Havakeshian, A. F. Mannion


November 2013, Volume 22, Issue 12, pp 2827 - 2835 Original Article Read Full Article 10.1007/s00586-013-2822-5

First Online: 23 May 2013

Purpose

Chronic musculoskeletal pain is often associated with psychological distress and maladaptive beliefs and these are sometimes reported to have a negative impact on surgical outcome. The influence of a surgical intervention, and in particular its outcome, on the course of change in psychological status is poorly documented. In this prospective study, we sought to examine the dynamic interplay between psychological factors and outcome in patients undergoing decompression surgery for spinal stenosis/herniated disc.

Methods

Before and 12 months after surgery, 159 patients (100 men, 59 women; 65 ± 11 years) completed a questionnaire booklet containing questions on socio-demographics, medical history, pain characteristics (intensity, frequency, use of medication), psychological disturbance [ZUNG Depression Scale and Modified Somatic Perception Questionnaire (MSPQ)], catastrophising (sub-scale of the Coping Strategies Questionnaire) and disability (Roland and Morris questionnaire) and the Fear Avoidance Beliefs Questionnaire about physical activity (FABQ-PA). The global outcome of surgery was assessed at 12 months using a five-point Likert scale and dichotomised as “good” (operation helped/helped a lot; coded 1) and “poor” (operation helped only little/did not help/made things worse; coded 0).

Results

Valid questionnaire data were available for 148 patients at 12 months’ follow-up: 113 (76.4 %) reported a good outcome and 35 (23.6 %) a poor outcome. In univariate analyses, the following baseline variables each significantly (p 

Conclusion

In a multivariable prospective (predictive) model, FABQ-PA was the only baseline psychological factor that significantly predicted outcome. Future studies should assess whether pre-operative cognitive–behavioural therapy in patients with maladaptive beliefs improves treatment outcome. Psychological disturbance did not significantly predict outcome, but it improved post-operatively in patients with a good outcome and worsened in those with a poor outcome. Rather than being a risk factor for poor outcome, in this group it appeared to be more a consequence of long-standing, unremitting pain that improved when symptoms resolved after successful surgery.


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