title: Pain Sensitivity and Pain Catastrophizing Are Associated With Persistent Pain and Disability After Lumbar Spine Surgery.
abstract: OBJECTIVE
  To examine whether pain sensitivity and pain catastrophizing are associated with persistent pain and disability after lumbar spine surgery.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Patients (N=68; mean age, 57.9±13.1y; 40 women [58.8%]) undergoing spine surgery for a degenerative condition from March 1, 2012 to April 30, 2013 were assessed 6 weeks, 3 months, and 6 months after surgery.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  The main outcome measures were persistent back pain intensity, pain interference, and disability. Patients with persistent back pain intensity, pain interference, or disability were identified as those patients reporting Brief Pain Inventory scores ≥4 and Oswestry Disability Index scores ≥21 at all postoperative time points.
  
  
  RESULTS
  From 6 weeks to 6 months after surgery, approximately 12.9%, 24.2%, and 46.8% of patients reported persistent back pain intensity, pain interference, or disability, respectively. Increased pain sensitivity at 6 weeks was associated with having persistent back pain intensity (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.0-4.1) after surgery. Increased pain catastrophizing at 6 weeks was associated with having persistent back pain intensity (OR, 1.1; 95% CI, 1.0-1.2), pain interference (OR, 1.1; 95% CI, 1.0-1.2), and disability (OR, 1.3; 95% CI, 1.1-1.4). An interaction effect was not found between pain sensitivity and pain catastrophizing on persistent outcomes (P>.05).
  
  
  CONCLUSIONS
  The findings suggest the importance of early postoperative screening for pain sensitivity and pain catastrophizing to identify patients at risk for poor postoperative pain intensity, pain interference, and/or disability outcomes. Future research should consider the benefit of targeted therapeutic strategies for patients with these postoperative prognostic factors.
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN.
authors.forename: Rogelio A
authors.initials: RA
authors.lastname: Coronado
authors.affiliation: Department of Physical Therapy, University of Florida, Gainesville, FL; Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN.
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University, Nashville, TN; Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN. Electronic address: kristin.archer@vanderbilt.edu.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
mesh_terms: D000368:Aged; D058443:Catastrophization; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold; D010149:Postoperative Pain / Q000453:epidemiology* / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D013130:Spinal Stenosis / Q000601:surgery*
keywords: Catastrophization; Low back pain; Lumbar stenosis; Pain threshold; Prognosis; Rehabilitation