Coexistence of pain and depression predicts poor 2-year surgery outcome among lumbar spinal stenosis patients.
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.
Sinikallio
Sanna
S
Department of Rehabilitation, Kuopio University Hospital, Kuopio, Finland. sanna.sinikallio@kuh.fi
Airaksinen
Olavi
O
Aalto
Timo
T
Lehto
Soili M
SM
Kröger
Heikki
H
Viinamäki
Heimo
H
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