Pain-Related Endurance, Fear-Avoidance and Somatosensory Sensitivity as Correlates of Clinical Status after Lumbar Disc Surgery

Most pain and disability variance in patients with low back pain still remains unexplained. The aim of this study was to enhance the degree of explained variance by including measures of pain and tactile sensitivity as well as pain-related endurance and fear-avoidance responses. Thirty-six post lumbar disc surgery patients completed psychometric questionnaires (Avoidance-Endurance Questionnaire, Fear-Avoidance Beliefs Questionnaire, Beck Depression Inventory) and underwent quantitative sensory testing (QST) with measures of pain (pressure (PPT) and mechanical pain threshold) and tactile sensitivity (MDT). Bivariate correlations and hierarchical multiple regression analysis were computed. In addition to the contribution of fear-avoidance responses, pressure pain sensitivity and endurance behavior significantly contributed to explanations of pain variance, whereas disability was primarily predicted by fear-avoidance. While all psychological variables and MDT were positively related to pain or disability, PPT was negatively related to pain. The regression model accounted for 69 % of the variance in back pain intensity and 68 % of the variance in disability. Tactile hypaesthesia was related to increased clinical pain. Pain-related endurance responses and pressure pain hyperalgesia were significant additional predictors for pain, but not for disability. These findings are compatible with generalized disinhibition via descending pathways and a general inhibition of tactile acuity by ongoing pain.

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471 FEAR‐AVOIDANCE‐AND ENDURANCE‐RELATED RESPONSES TO PAIN 6 MONTHS AFTER LUMBAR DISC SURGERY: CORRELATIONS WITH THE CORTISOL AWAKENING RESPONSE

European Journal of Pain ◽

10.1016/s1090-3801(09)60474-2 ◽

2009 ◽

Vol 13 (S1) ◽

Author(s):

S. Sudhaus ◽

T. Möllenberg ◽

C. Strathmann ◽

R. Willburger ◽

K. Schmieder ◽

...

Keyword(s):

Lumbar Disc ◽

Lumbar Disc Surgery ◽

Cortisol Awakening Response ◽

Fear Avoidance ◽

Disc Surgery

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An epidemiological surveillance network of lumbar disc surgery to help prevention of and compensation for low back pain

European Journal of Public Health ◽

10.1093/eurpub/ckv240 ◽

2016 ◽

Vol 26 (4) ◽

pp. 543-548 ◽

Cited By ~ 3

Author(s):

Natacha Fouquet ◽

Alexis Descatha ◽

Catherine Ha ◽

Audrey Petit ◽

Yves Roquelaure

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Disc ◽

Epidemiological Surveillance ◽

Lumbar Disc Surgery ◽

Low Back ◽

Surveillance Network ◽

Disc Surgery

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Cortisol Awakening Response and Pain-Related Fear-Avoidance Versus Endurance in Patients Six Months After Lumbar Disc Surgery

Applied Psychophysiology and Biofeedback ◽

10.1007/s10484-012-9186-1 ◽

2012 ◽

Vol 37 (2) ◽

pp. 121-130 ◽

Cited By ~ 6

Author(s):

Sigrid Sudhaus ◽

Thomas Möllenberg ◽

Heike Plaas ◽

Roland Willburger ◽

Kirsten Schmieder ◽

...

Keyword(s):

Lumbar Disc ◽

Lumbar Disc Surgery ◽

Cortisol Awakening Response ◽

Fear Avoidance ◽

Disc Surgery

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Fear avoidance beliefs and quality of life quality after lumbar disc surgery

Journal of Cognitive-Behavioral Psychotherapy and Research ◽

10.5455/jcbpr.245356 ◽

2017 ◽

pp. 1

Author(s):

Dogan Guclu ◽

Omer Senormanci ◽

Oya Gonullu ◽

Musa Cirak ◽

Guliz Senomanci ◽

...

Keyword(s):

Quality Of Life ◽

Lumbar Disc ◽

Life Quality ◽

Lumbar Disc Surgery ◽

Fear Avoidance ◽

Fear Avoidance Beliefs ◽

Disc Surgery

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THE ROLE OF LOCAL SOLU-MEDROL IN POSTOPERATIVE PAIN RELIEF AFTER LUMBAR DISC SURGERY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.5.6 ◽

2011 ◽

pp. 40-44

Author(s):

Keyword(s):

Back Pain ◽

Pain Relief ◽

Lumbar Disc ◽

Early Postoperative Period ◽

Leg Pain ◽

Lumbar Disc Surgery ◽

Control Group ◽

Steroid Group ◽

Disc Surgery

Objectives: The aim of this study is to evaluate analgesic effect of local Solu-Medrol in following lumbar disc surgery. Methods: A prospective, randomized case-control study included 49 patients, divided into 2 groups (24: control group, 25: steroid group). After discectomy, a piece of gelfoam soaked with 40 mg Solu-Medrol was left on the affected root in the steroid group. In the control group, saline soaked gelfoam was applied to the nerve root. T test to compare VAS between the two groups. Results: 24 patients (15 males, 9 females) average age of 30.2 in the control group, 25 patients (18 males, 7 females) average aged 29.8 in the steroid group. Average follow-up time 14.5 months for the control group, 14.2 months for the steroid group. Statistically significant back pain and leg pain relief (p<0.01) was observed at 1 week, 2 weeks and 1 month, but it became insignificant after 3 months. Without any complications could be related to the steroid. Conclusions: Local Solu-Medrol 40 mg is a safe and effective method in reducing back pain and radicular leg pain in early postoperative period. Key words: Local Solu-Medrol; Lumbar disc surgery.

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Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.2.121 ◽

2007 ◽

Vol 6 (2) ◽

pp. 121-125 ◽

Cited By ~ 42

Author(s):

Kadir Kotil ◽

Tamer Tunckale ◽

Zeynep Tatar ◽

Macit Koldas ◽

Alev Kural ◽

...

Keyword(s):

Back Pain ◽

Muscle Injury ◽

Creatine Phosphokinase ◽

Lumbar Disc ◽

Lumbar Disc Surgery ◽

Pain Scores ◽

Disc Surgery ◽

Serum Creatine Phosphokinase ◽

Significant Difference ◽

Group B

Object The aim of this study was to determine the extent of muscle injury caused by continuous or intermittent muscle retraction during macro- and microdiscectomy in lumbar disc surgery. Pain scores, serum creatine phosphokinase (CPK) levels, and histological findings obtained in muscle specimens were compared. Methods Sixty patients who underwent surgery for a one-level disc herniation during a 1-year period (January 2004–January 2005) and who had similar demographic characteristics were randomly assigned to one of four groups, each consisting of 15 patients: Group A, microdiscectomy in which the retractor was never released; Group B, microdiscectomy in which the retractor was released every 15 minutes; Group C, macrodiscectomy in which the retractor was never released; and Group D, macrodiscectomy in which the retractor was released every 15 minutes. Muscle biopsy samples were acquired in each group, and biochemical studies were conducted to determine serum CPK levels. The duration of muscle retraction was 15 minutes followed by 3 minutes of relaxation in Groups B and D. In all groups, muscle degeneration and elevation in serum CPK levels were observed immediately after surgery. The overall results, however, were different. The decline of serum CPK levels started 1 week after surgery. The smallest degree of muscle injury (reflected by the lowest serum CPK level) was observed in Group B. When the pre- and postoperative CPK values were compared in all groups, the patients in Groups B and D reported the least amount of back pain (p < 0.001). No significant differences in serum CPK levels were observed between Groups A and C or between Groups B and D. The extent of back pain was evaluated using a visual analog scale, and the consumption of analgesics was also assessed. The groups exhibited significantly different responses: the lowest analgesic consumption and the lowest pain scores were demonstrated in Groups B and D. Conclusions In this prospective randomized clinical trial, the authors determined that muscle injury during lumbar disc surgery was closely related to muscle retraction and relaxation times whereas the size of the paravertebral skin incision had no effect on postoperative back pain and disability. There was no significant difference among the groups in terms of back pain during the long-term follow-up period (18–19 months).

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