Date Published: January 20, 2017
Publisher: Public Library of Science
Author(s): Marie Dorow, Margrit Löbner, Janine Stein, Alexander Konnopka, Hans J. Meisel, Lutz Günther, Jürgen Meixensberger, Katarina Stengler, Hans-Helmut König, Steffi G. Riedel-Heller, Luigi Maria Cavallo.
Pain relief has been shown to be the most frequently reported goal by patients undergoing lumbar disc surgery. There is a lack of systematic research investigating the course of postsurgical pain intensity and factors associated with postsurgical pain. This systematic review focuses on pain, the most prevalent symptom of a herniated disc as the primary outcome parameter. The aims of this review were (1) to examine how pain intensity changes over time in patients undergoing surgery for a lumbar herniated disc and (2) to identify socio-demographic, medical, occupational and psychological factors associated with pain intensity.
Selection criteria were developed and search terms defined. The initial literature search was conducted in April 2015 and involved the following databases: Web of Science, Pubmed, PsycInfo and Pubpsych. The course of pain intensity and associated factors were analysed over the short-term (≤ 3 months after surgery), medium-term (> 3 months and < 12 months after surgery) and long-term (≥ 12 months after surgery). From 371 abstracts, 85 full-text articles were reviewed, of which 21 studies were included. Visual analogue scales indicated that surgery helped the majority of patients experience significantly less pain. Recovery from disc surgery mainly occurred within the short-term period and later changes of pain intensity were minor. Postsurgical back and leg pain was predominantly associated with depression and disability. Preliminary positive evidence was found for somatization and mental well-being. Patients scheduled for lumbar disc surgery should be selected carefully and need to be treated in a multimodal setting including psychological support.
Lumbar disc herniations are presumed to play a major role in the estimated 74–100% lifetime incidence of back pain [1–3]. In Germany, the estimated incidence of lumbar disc herniation is 150/100,000 per year .
The objectives of this review were (1) to examine how pain intensity changes over time in disc surgery patients and (2) to identify factors associated with pain intensity. In conclusion, average pain scores were moderate to severe before surgery and only mild to moderate after surgery. In addition, the short-term postoperative outcome seems to be a reliable predictor of the long-term outcome, because later changes of pain intensity were minor. This review revealed several significant associations with pain intensity in disc surgery patients. These are of high relevance when it comes to selecting patients with uncertain indications for surgery due to herniated disc and identifying patients at risk for developing chronic pain. The most salient factor for ongoing postsurgical pain was depression. Rather than performing a unimodal surgical treatment, a multimodal treatment setting including a cooperating interdisciplinary team seems necessary to achieve substantial and long-lasting pain relief in patients who undergo surgery for disc herniation. Therefore, screening instruments should routinely be applied to identify those disc surgery patients who are in need of concomitant psychological treatment. Individualized support may positively influence the compliance during rehabilitation, which in turn may lead to a faster recovery and improved long-term outcomes. The effectiveness of additional psychological interventions needs to be studied in disc surgery patients in future research.