title: Coexistence of pain and depression predicts poor 2-year surgery outcome among lumbar spinal stenosis patients.
abstract: BACKGROUND
  Lumbar spinal stenosis is a common cause of back and leg pain with the most severe cases treated surgically. Regarding the surgery outcome, the importance of early postoperative depression and pain is unknown.
  
  
  OBJECTIVE
  To examine whether the coexistence of pain and depressive symptoms on 3-month follow-up predicts the 2-year surgery outcome.
  
  
  METHODS
  93 patients (mean age 62 years) with symptomatic lumbar spinal stenosis underwent decompressive surgery. They completed the same set of questionnaires, 3 months, 1 year and 2 years postoperatively. Depression was assessed with the 21-item Beck Depression Inventory (BDI). Physical functioning and pain were assessed with the Oswestry Disability Index, the Stucki Questionnaire, self-reported walking ability, the visual analogue scale (VAS) and pain drawing. Comparisons were made between groups according to the "misery" (i.e. the coexistence of elevated pain and depression on 3-month follow-up) status. Logistic regression analysis was used to examine the factors independently associated with a poor surgery outcome on 2-year follow-up.
  
  
  RESULTS
  The patients in the misery group (n=24) showed greater symptom severity and greater disability than the patients in the non-misery group (n=69) at all follow-up stages. No clinical improvement was seen in the misery group during the follow-up. An independent association was observed between belonging to the misery group and 2-year disability, symptom severity and poor walking capacity.
  
  
  CONCLUSIONS
  Even moderately increased VAS and BDI scores, when presenting simultaneously on an individual patient level during the early postoperative period, imply a strong clinical burden and a risk factor for poor recovery. The assessment of pain and depressive symptoms is encouraged.
authors.affiliation: Department of Rehabilitation, Kuopio University Hospital, Kuopio, Finland. sanna.sinikallio@kuh.fi
authors.forename: Sanna
authors.initials: S
authors.lastname: Sinikallio
authors.forename: Olavi
authors.initials: O
authors.lastname: Airaksinen
authors.forename: Timo
authors.initials: T
authors.lastname: Aalto
authors.forename: Soili M
authors.initials: SM
authors.lastname: Lehto
authors.forename: Heikki
authors.initials: H
authors.lastname: Kröger
authors.forename: Heimo
authors.initials: H
authors.lastname: Viinamäki
mesh_terms: D000368:Aged; D001416:Back Pain / Q000523:psychology* / Q000601:surgery*; D019299:Decompression, Surgical / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000523:psychology / Q000601:surgery; D010147:Pain Measurement; D010149:Postoperative Pain / Q000523:psychology*; D010555:Personality Inventory / Q000706:statistics & numerical data; D011128:Polyradiculopathy / Q000523:psychology / Q000601:surgery; D011379:Prognosis; D011594:Psychometrics; D012803:Sick Role; D013126:Spinal Nerve Roots / Q000601:surgery; D013130:Spinal Stenosis / Q000523:psychology* / Q000601:surgery*; D016896:Treatment Outcome