Continued disability and pain after lumbar disc surgery: the role of cognitive-behavioral factors.
Cognitive-behavioral factors are considered important in the development of chronic disability and pain in patients with low back pain. In a prospective cohort study of 277 patients undergoing surgery for lumbosacral radicular syndrome, the predictive value of preoperatively measured cognitive-behavioral factors (fear of movement/(re)injury, passive pain coping, and negative outcome expectancies) for disability and pain intensity at 6 weeks and 6 months after surgery was investigated, taking into account the effect of possible confounding variables. Higher levels of cognitive-behavioral factors were found to be associated with a worse outcome at both 6 weeks and 6 months. These associations remained significant after controlling for possible confounding variables (preoperative disability and pain intensity, age, gender, educational level, duration of complaints, neurological deficits, and intake of analgesics) and pain intensity 3 days postoperatively. In multiple regression analyses, the cognitive-behavioral factors independently predicted different outcomes. Fear of movement/(re)injury predicted more disability and more severe pain at 6 weeks and more severe pain at 6 months; passive pain-coping strategies predicted more disability at 6 months; and negative outcome expectancies predicted more disability and more severe pain at both 6 weeks and 6 months. The findings support the potential utility of preoperative screening measures that include cognitive-behavioral factors for predicting surgical outcome, as well as studies to examine the potential benefits of cognitive-behavioral treatment to improve surgical outcome.
Department of Physical Therapy, University Radboud Nijmegen Medical Centre, The Netherlands. J.denBoer@fysio.umcn.nl
Jasper J
JJ
den Boer
Rob A B
RA
Oostendorp
Tjemme
T
Beems
Marten
M
Munneke
Andrea W M
AW
Evers
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D004185:Disability Evaluation; D017586:Diskectomy / Q000523:psychology; D005239:Fear; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D017116:Low Back Pain / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000601:surgery*; D009460:Neurologic Examination; D010147:Pain Measurement; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012008:Recurrence; D012585:Sciatica / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D013126:Spinal Nerve Roots; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000700:Analgesics