The Relationship Between Pain and Depressive Symptoms After Lumbar Spine Surgery

Overview

Journal Pain

Specialties Neurology
Psychiatry

Date 2012 Aug 8

PMID 22867701

Citations 7

Authors

Richard L Skolasky

Lee H Riley 3rd

Anica M Maggard

Stephen T Wegener

Affiliations

Soon will be listed here.

Abstract

Although depressive symptoms are common among those living with back pain, there is limited information on the relationship between postsurgical pain reduction and changes in depressive symptoms. The objective of this prospective cohort study was to examine the change in pain and depressive symptoms and to characterize the relationship between pain and depressive symptoms after lumbar spine surgery. We assessed 260 individuals undergoing lumbar spine surgery preoperatively and postoperatively (3 and 6 months) using a pain intensity numeric rating scale and the Patient Health Questionnaire depression scale. The relationship between change in pain (a 2-point decrease or 30% reduction from the preoperative level) and depressive symptoms was examined using standard regression methods. Preoperatively, the mean pain intensity was 5.2 (SD 2.4) points, and the mean depressive symptom score was 5.03 (SD 2.44) points. At 3 months, individuals who experienced a reduction in pain (63%) were no more likely to experience a reduction in depressive symptoms (odds ratio 1.07, 95% confidence interval [CI] .58 to 1.98) than individuals who experienced no change from preoperative pain (34%). However, at 6 months, individuals who experienced a reduction in pain (63%) were nearly twice as likely to experience a reduction in depressive symptoms (odds ratio 1.93, 95% CI 1.15 to 3.25) as those who experienced no change or an increase in pain (31%). We found that most individuals experienced clinically important reductions in pain after surgery. We concluded that those whose pain level was reduced at 6 months were more likely to experience a reduction in depressive symptoms.

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References

Skolasky R, MacKenzie E, Wegener S, Riley 3rd L . Patient activation and adherence to physical therapy in persons undergoing spine surgery. Spine (Phila Pa 1976). 2008; 33(21):E784-91. PMC: 6153437. DOI: 10.1097/BRS.0b013e31818027f1. View

Lindsay P, Wyckoff M . The depression-pain syndrome and its response to antidepressants. Psychosomatics. 1981; 22(7):571-3, 576-7. DOI: 10.1016/S0033-3182(81)73478-9. View

Hilibrand A, Rand N . Degenerative lumbar stenosis: diagnosis and management. J Am Acad Orthop Surg. 1999; 7(4):239-49. DOI: 10.5435/00124635-199907000-00004. View

Greenspan J, Craft R, LeResche L, Arendt-Nielsen L, Berkley K, Fillingim R . Studying sex and gender differences in pain and analgesia: a consensus report. Pain. 2007; 132 Suppl 1:S26-S45. PMC: 2823483. DOI: 10.1016/j.pain.2007.10.014. View

Farrar J, Young Jr J, Lamoreaux L, Werth J, Poole M . Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001; 94(2):149-158. DOI: 10.1016/S0304-3959(01)00349-9. View

Munce S, Stansfeld S, Robertson Blackmore E, Stewart D . The role of depression and chronic pain conditions in absenteeism: results from a national epidemiologic survey. J Occup Environ Med. 2007; 49(11):1206-11. DOI: 10.1097/JOM.0b013e318157f0ba. View

Fillingim R, King C, Ribeiro-Dasilva M, Rahim-Williams B, Riley 3rd J . Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 2009; 10(5):447-85. PMC: 2677686. DOI: 10.1016/j.jpain.2008.12.001. View

Dickens C, McGowan L, Clark-Carter D, Creed F . Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis. Psychosom Med. 2002; 64(1):52-60. DOI: 10.1097/00006842-200201000-00008. View

Fishbain D, Cutler R, Rosomoff H, Rosomoff R . Chronic pain-associated depression: antecedent or consequence of chronic pain? A review. Clin J Pain. 1997; 13(2):116-37. DOI: 10.1097/00002508-199706000-00006. View

10.

Gagliese L, Weizblit N, Ellis W, Chan V . The measurement of postoperative pain: a comparison of intensity scales in younger and older surgical patients. Pain. 2005; 117(3):412-420. DOI: 10.1016/j.pain.2005.07.004. View

11.

Deyo R, Gray D, Kreuter W, Mirza S, Martin B . United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976). 2005; 30(12):1441-5. DOI: 10.1097/01.brs.0000166503.37969.8a. View

12.

Dworkin R, Turk D, Farrar J, Haythornthwaite J, Jensen M, Katz N . Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2004; 113(1-2):9-19. DOI: 10.1016/j.pain.2004.09.012. View

13.

CULLEN M, Staren E, Logas W, Ivankovich A, ECONOMOU S . Continuous epidural infusion for analgesia after major abdominal operations: a randomized, prospective, double-blind study. Surgery. 1985; 98(4):718-28. View

14.

Poleshuck E, Bair M, Kroenke K, Damush T, Krebs E, Giles D . Musculoskeletal pain and measures of depression: response to comment on the article by Poleshuck et al. Gen Hosp Psychiatry. 2010; 32(1):114-5. PMC: 2909700. DOI: 10.1016/j.genhosppsych.2009.09.007. View

15.

Kehlet H, Jensen T, Woolf C . Persistent postsurgical pain: risk factors and prevention. Lancet. 2006; 367(9522):1618-25. DOI: 10.1016/S0140-6736(06)68700-X. View

16.

Ashburn M, Fine P . Persistent pain following trauma. Mil Med. 1989; 154(2):86-9. View

17.

Kumar R, Menon K, Ranjith T . Use of epidural analgesia for pain management after major spinal surgery. J Orthop Surg (Hong Kong). 2003; 11(1):67-72. DOI: 10.1177/230949900301100114. View

18.

Herr K, Spratt K, Mobily P, Richardson G . Pain intensity assessment in older adults: use of experimental pain to compare psychometric properties and usability of selected pain scales with younger adults. Clin J Pain. 2004; 20(4):207-19. DOI: 10.1097/00002508-200407000-00002. View

19.

Atkinson H, Slater M, Patterson T, Grant I, Garfin S . Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain: a controlled study. Pain. 1991; 45(2):111-121. DOI: 10.1016/0304-3959(91)90175-W. View

20.

Skolasky R, MacKenzie E, Riley 3rd L, Wegener S . Psychometric properties of the Patient Activation Measure among individuals presenting for elective lumbar spine surgery. Qual Life Res. 2009; 18(10):1357-66. PMC: 3561629. DOI: 10.1007/s11136-009-9549-0. View