Abstract
Introduction
Chronic pain is one of the adverse outcomes in surgery for degenerative lumbar pathology (DLP). Postoperative complications as DVT, and chronic pain in pathologies as thoracotomy or breast cancer have been associated with poor control of postoperative pain.
Study design
Prospective study of patients undergoing surgery for DLP.
Purpose
To evaluate the relationship of postoperative pain with final outcomes in terms of chronic pain and quality of life.
Outcome measures
Visual analogue scales (VAS) to assess lumbar and leg pain, Short Form-36v2 (SF-36), Oswestry Disability Index (ODI) and Core Outcome Measures Index (COMI).
Method
263 patients with a mean age of 54.0 years (22–86 y) were reviewed and 131 patients were women (49.8%). Pain, quality of life and disability of patients were assessed in the immediate preoperative and 2 years after surgery. Epidemiological data collected were age, sex, educational level, employment status, diagnosis, treatment, and comorbidity (ASA). An external nurse evaluated postoperative pain four times every day and we selected the worst value of day. The reference value of postoperative pain was the VAS of third day when patient starts standing and PCA is removed. To compare means we used t-Student and Pearson's coefficient or Spearman's test was used to assess the correlation, and, finally, linear regression study (ANOVA) was performed with variables that showed statistically significant correlation. SPSS 15.0 statistical package.
Results
The mean value of VAS on 3rd day (VAS-3) was 2.86 ± 2.2.
Postoperative pain showed a moderately positive correlation with final pain, measured by Bodily Pain (r=0.310, p <0.05) and final VAS (r=0.318, p <0.001), and moderately negative with the Physical Component Scale of the SF36 (r=−0.269, p <0.05). No significant correlations existed with the other instruments. Preoperative pain, sex and MSC-SF36 was correlated with postoperative pain (r=0.262 p <0.05; r=− 0.261 p <0.003, r=− 0.306 p <0.001).
According to linear regression studies each point in the VAS-3 will be an increase of 0.522 points in the final VAS (p <0.01).
Conclusions
Postoperative pain has moderate but statistically significant influence in the final lumbar pain perception, assessed by VAS and Bodily Pain. Postoperative pain has an inverse relationship to the physical component of SF-36. However, postoperative pain is not correlated with disability measured by ODI or COMI.
