Influence of Preoperative Pain, Cognitions, and Quantitative Sensory Testing Measures on the Effects of Perioperative Pain Neuroscience Education for People Receiving Surgery for Lumbar Radiculopathy: Secondary Analysis of a Randomized Controlled Trial.

Abstract

<b>OBJECTIVE:</b> To explore whether preoperative pain intensity, pain cognitions, and quantitative sensory measures influence the established effectiveness of perioperative pain neuroscience education (PPNE) on health-related quality of life at 1 year after surgery for lumbar radiculopathy. <b>DESIGN:</b> Secondary analysis of a triple-blinded randomized controlled trial. <b>METHODS:</b> Participants (n = 90) were Dutch-speaking adults (18-65 years) who were scheduled for surgery for lumbar radiculopathy in 3 Belgian hospitals. They were randomized (1:1) to receive PPNE (n = 41) or perioperative biomedical education (n = 49). Linear mixed models were built for health-related quality of life (ie, SF-6D utility values, Physical and Mental Component of the 36-item Short Form Health Survey) using the following independent variables: therapy, time, and preoperative scores for back and leg pain intensity, pain catastrophizing, kinesiophobia, hypervigilance, and quantitative sensory measures. <b>RESULTS:</b> The impact of PPNE on SF-6D utility values over time was influenced by kinesiophobia (F = 3.30, <i>P</i> = .02) and leg pain intensity (F = 3.48, <i>P</i> = .02). Regardless of the intervention, back pain intensity negatively influenced SF-6D values over time (F = 3.99, <i>P</i> = .009). The Physical Component scores were negatively impacted by back pain intensity (F = 9.08, <i>P</i> = .003) and were influenced over time by leg pain intensity (F = 2.87, <i>P</i> = .04). The Mental Component scores were negatively impacted by back pain intensity (F = 6.64, <i>P</i> = .01) and pain catastrophizing (F = 5.42, <i>P</i> = .02), as well as hypervigilance (F = 3.16, <i>P</i> = .03) and leg pain intensity (F = 3.12, <i>P</i> = .03) over time. <b>CONCLUSION:</b> PPNE may be more effective than perioperative biomedical education in improving postoperative health utility values in patients who reported higher kinesiophobia and leg pain intensity before surgery for lumbar radiculopathy. <i>J Orthop Sports Phys Ther 2024;54(4):1-10. Epub 8 January 2024. doi:10.2519/jospt.2024.12051</i>.