Can quantitative sensory tests predict failed back surgery?: A prospective cohort study.

Müller, Monika; Limacher, Andreas; Agten, Christoph A; Treichel, Fabienne; Heini, Paul; Seidel, Ulrich; Andersen, Ole K; Arendt-Nielsen, Lars; Jüni, Peter; Curatolo, Michele (2019). Can quantitative sensory tests predict failed back surgery?: A prospective cohort study. European journal of anaesthesiology, 36(9), pp. 695-704. Lippincott Williams & Wilkins 10.1097/EJA.0000000000001012

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BACKGROUND Failed back surgery syndrome (FBSS) is a pain condition refractory to therapy, and is characterised by persistent low back pain after spinal surgery. FBSS is associated with severe disability, low quality of life and high unemployment. We are currently unable to identify patients who are at risk of developing FBSS. Patients with chronic low back pain may display signs of central hypersensitivity as assessed by quantitative sensory tests (QST). This can contribute to the risk of developing persistent pain after surgery. OBJECTIVE We tested the hypothesis that central hypersensitivity as assessed by QST predicts FBSS. DESIGN Prospective cohort study. SETTING Three tertiary care centres. PATIENTS 141 patients scheduled for up to three segment spinal surgery for chronic low back pain (defined as at least 3 on a numerical rating scale on most days during the week and with a minimum duration of 3 months) due to degenerative changes. OUTCOMES We defined FBSS as persistent pain, persistent disability or a composite outcome defined as either persistent pain or disability. The primary outcome was persistent pain 12 months after surgery. We applied 14 QST using electrical, pressure and temperature stimulation to predict FBSS and assessed the association of QST with FBSS in multivariable analyses adjusted for sociodemographic, psychological and clinical and surgery-related characteristics. RESULTS None of the investigated 14 QST predicted FBSS, with 95% confidence intervals of crude and adjusted associations of all QST including one as a measure of no association. Results remained robust in all sensitivity and secondary analyses. CONCLUSION The study indicates that assessment of altered central pain processing using current QST is unlikely to identify patients at risk of FBSS and is therefore unlikely to inform clinical decisions.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > University Psychiatric Services > University Hospital of Psychiatry and Psychotherapy > Translational Research Center
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Müller, Monika; Limacher, Andreas; Treichel, Fabienne and Seidel, Ulrich

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0265-0215

Publisher:

Lippincott Williams & Wilkins

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

08 Aug 2019 12:20

Last Modified:

05 Sep 2019 11:36

Publisher DOI:

10.1097/EJA.0000000000001012

PubMed ID:

31368907

BORIS DOI:

10.7892/boris.132359

URI:

https://boris.unibe.ch/id/eprint/132359

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