INTRADISCAL ELECTROTHERMAL THERAPY: THE USE OF PAIN DIAGRAMS IN PREOPERATIVE PSYCHOLOGICAL ASSESSMENT

Abstract

Purpose of Study: To determine whether preprocedure psychological assessment can be used to predict the outcome following intradiscal electrothermal therapy (IDET).

Materials and Methods: Patients undergoing IDET at our unit between April 2000 and March 2002 were asked to complete a pain diagram and a Short Form 36 (SF36) (UK Version 1). Patients were followed up after IDET by means of a postal questionnaire. Patients outcome was assessed using a visual analogue pain score (VAS), an SF36 and a subjective outcome assessment. Pain drawings were classified as organic and non-organic according to the principle described by Mann et al.

Results: Forty-six (80.7%) patients were successfully followed up. Mean age was 41.2 years (range 16–76), 27 were female and 19 male. 73.9% of the pain diagrams were classified as organic and 26.1% as non-organic. The pain diagram was a good predictive tool for outcome following IDET. Patients with ‘organic’ pain drawings showed an improvement in mean pain VAS (pre 6.7, post 5.9), high patient satisfaction (Better 67.6%, Same 11.8%, Worse 20.6%), and higher physical component scores of the SF36 (Physical 64.1, Physical Role 45.6, Pain 54.0) compared to the ‘non-organic’ group who demonstrated a deterioration in mean pain VAS (pre 6.5, post 8.2), low patient satisfaction (Better 8.3%, Same 58.3%, Worse 33.3%), and lower physical component scores of the SF36 (Phsical 38.3, Physical Role 20.8, Pain 26.5).

Conclusions: Several authors have shown that certain preoperative psychological characteristics are associated with a poor outcome from spinal surgery. Some authors have demonstrated a correlation between these characteristics and pain diagrams when they are judged as ‘organic’ and ‘non-organic’. Our findings suggest that preprocedure psychological assessment is useful in predicting which patients will have a favourable outcome from IDET.

Pain drawings are quick and easy for patients to complete. Our study demonstrates pain drawings can reliably be used to predict outcome following intradiscal electrothermal therapy.