Download PDF
J Neurol Surg A Cent Eur Neurosurg 2012; 73(06): 387-396
DOI: 10.1055/s-0032-1313642
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Short Psychological Intervention as a Perioperative Pain Reduction Treatment in Spinal Neurosurgery[*]

R. Reichart
1   Department of Neurosurgery, Friedrich-Schiller-University, Jena, Germany
*   These authors contributed equally
,
I. Vogel
1   Department of Neurosurgery, Friedrich-Schiller-University, Jena, Germany
*   These authors contributed equally
,
T. Weiss
2   Department of Biological and Clinical Psychology, Friedrich-Schiller-University, Jena, Germany
,
S. Hennig
2   Department of Biological and Clinical Psychology, Friedrich-Schiller-University, Jena, Germany
,
J. Walter
1   Department of Neurosurgery, Friedrich-Schiller-University, Jena, Germany
,
R. Kalff
1   Department of Neurosurgery, Friedrich-Schiller-University, Jena, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 May 2012 (online)

    Permissions and Reprints

See also:

Short Psychological Intervention as a Perioperative Pain Reduction Treatment in Spinal NeurosurgeryCent Eur Neurosurg 2011; 72(S 01): e38-e38
DOI: 10.1055/s-0031-1286262

Abstract

Study Aims The aim of the present pilot study was to test the feasibility of an innovative Short Psychological Intervention (SPI) for back pain patients as part of an acute inpatient neurosurgical treatment. Fear and fear-avoidance beliefs have been shown to influence the functional outcome in chronic back pain (CBP) patients. Therefore, a reduction of fear and fear-avoidance beliefs should improve the functional outcome and reduce pain in the acute neurosurgical setting.

Patients and Methods 39 patients were studied in a randomized prospective longitudinal study. The patients had severe degenerative spinal disease and had undergone posterior lumbar interbody fusion.

Results All patients enrolled in the study were investigated in the immediate preoperative period and 6 weeks postoperatively using a package of standardized questionnaires in which pain intensity, fear-avoidance beliefs, and physical fitness were recorded. In 19 of the patients, the surgical procedure was supplemented by a SPI based on methods to increase self-efficacy by reducing fear-avoidance beliefs. While the intervention group reported a significantly greater reduction in the highest pain intensity and a better physical fitness compared to the control group, we did not find a significant decrease in fear-avoidance beliefs in the intervention group at the second time of assessment, possibly due to the relatively small sample size.

Conclusions The study confirmed that psychological interventions can offer significant benefits when used in the acute inpatient setting as the outcome of surgery can be positively influenced. Future studies should focus on cost savings related to improved postoperative recovery and a possible reduction of chronic postoperative pain.

Keywords

short psychological ­intervention - fear-avoidance beliefs - spine surgery - physical fitness

* This article was originally published online in Central European Neurosurgery on November 16, 2011 (DOI:10.1055/s-0031-1286262)


 

  • References

  • 1 Benedetti F, Mayberg HS, Wager TD , et al. Neurobiological mechanisms of the placebo effect. J Neurosci 2005; 25 (45) 10390-10402
    CrossrefPubMedGoogle Scholar
  • 2 Block AR, Gatchel RJ, Deardorff WW , et al. The Psychology of Spine Surgery. Washington DC: American Psychological Association; 2003
    CrossrefGoogle Scholar
  • 3 Block AR, Ohnmeiss DD, Guyer RD , et al. The use of presurgical psychological screening to predict the outcome of spine surgery. Spine J 2001; 1: 274-282
    CrossrefPubMedGoogle Scholar
  • 4 Boersman K, Linton SJ. Screening to identify patients at risk: Profiles of psychological risk factors for early intervention. Clin J Pain 2005; 21: 38-43
    CrossrefPubMedGoogle Scholar
  • 5 Branch ChL, Branch Jr ChL. Posterior lumbar interbody fusion: The keystone technique. In: Lin PM, Gill K, eds. Lumbar Interbody Fusion: Principles and Techniques in Spine Surgery. Rockville, MD: Aspen Publishers; 1989: 211-219
    Google Scholar
  • 6 Brox JI, Reikerås O, Nygaard Ø , et al. Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: A prospective randomized controlled study. Pain 2006; 122: 145-155
    CrossrefPubMedGoogle Scholar
  • 7 Childs JD, Fritz JM, Flynn TW , et al. A clinical prediction rule to identifiy patients with low back pain most likely to benefit from spinal manipulation: A validation study. Ann Intern Med 2004; 141: 920-928
    CrossrefPubMedGoogle Scholar
  • 8 De Cosmo G, Congedo E, Lai C , et al. Pre-operative psychologic and demographic predictors of pain perception and Tramadol consumption using intravenous patient-controlled analgesia. Clin J Pain 2008; 24 (05) 399-405
    CrossrefPubMedGoogle Scholar
  • 9 De Groot KI, Boeke S, Van den Berge HJ , et al. The influence of psychological variables on postoperative anxiety and physical complaints in patients undergoing lumbar surgery. Pain 1997; 69: 19-25
    CrossrefPubMedGoogle Scholar
  • 10 Den Boer JJ, Oostendorp RAB, Beems T , et al. Continued disability and pain after lumbar disc surgery: The role of cognitive behavioral factors. Pain 2006; 123: 45-52
    CrossrefPubMedGoogle Scholar
  • 11 Denison E, Asenlöf P, Sandborgh M , et al. Musculosketal pain in primary health care: Subgroups based on pain intensity, disability, self-efficacy and fear-avoidance variables. J Pain 2007; 8: 67-74
    CrossrefPubMedGoogle Scholar
  • 12 Devine EC. Effects of psychoeducational care for adult surgical patients. A meta-analysis of 191 studies. Patient Educ Couns 1992; 19: 129-142
    CrossrefPubMedGoogle Scholar
  • 13 Fillingim RB, King CD, Ribeiro-Dasilva MC , et al. Sex, gender, and pain: A review of recent clinical and experimental findings. J Pain 2009; 10 (5) 447-485
    PubMedGoogle Scholar
  • 14 Friedrich M, Gittler G, Arendasy M , et al. Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain. Spine 2005; 30 (9) 995-1000
    CrossrefPubMedGoogle Scholar
  • 15 Fritz JM, George SZ. Identifying psychological variables in patients with acute work-related low back pain: The importance of fear-avoidance beliefs. Phys Ther 2002; 82 (10) 973
    PubMedGoogle Scholar
  • 16 George SZ, Wallace MR, Wright TW , et al. Evidence for a biopsychological influence on shoulder pain: Pain catastrophizing and catechol-O-methyltransferase (COMT) diplotype predict clinical pain ratings. Pain 2008; 136 (1/2) 53-61
    CrossrefPubMedGoogle Scholar
  • 17 Göhner W, Schlicht W. Preventing chronic back pain: Evaluation of a theory based cognitive-behavioural training program for patients with subacute back pain. Patient Educ Couns 2006; 64 (1/3) 87-95
    CrossrefPubMedGoogle Scholar
  • 18 Gollwitzer PM. Goal achievement: The role of intentions. In: Stroebe WM. 1993
    Google Scholar
  • 19 Gramke HF, de Rijke JM, van Kleef M , et al. Predictive factors of postoperative pain after day-case surgery. Clin J Pain 2009; 25 (6) 455-460
    CrossrefPubMedGoogle Scholar
  • 20 Haase I, Schwarz A, Burger A , et al. Der Funktionsfragebogen Hannover (FFbH) und die Subskala “körperliche Funktionsfähigkeit” aus dem SF-36 im Vergleich. Rehabilitation 2001; 40: 40-42
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Hope P. Assessment and treatment of patients presenting with low back pain and accompanying psychological distress: An evidence-based approach. Physiotherapy 2002; 88 (12) 745-750
    CrossrefPubMedGoogle Scholar
  • 22 Kagan I, Bar-Tal Y. The effect of pre-operative uncertainty and anxiety on short-term recovery after elective arthroplasty. J Clin Nurs 2006; 17: 576-583
    PubMedGoogle Scholar
  • 23 Kain ZN, Severino F, Alexander GM , et al. Pre-operative anxiety and postoperative pain in women undergoing hysterectomy: A repeated-measures design. J Psychosom Res 2000; 49: 417-422
    CrossrefPubMedGoogle Scholar
  • 24 Kessler RS, Patterson DR, Dane J. Hypnosis and relaxation with pain patients: Evidence for effectiveness. Semin Pain Med 2003; 1 (2) 67-76
    CrossrefPubMedGoogle Scholar
  • 25 Kohlmann T, Raspe H. Der Funktionsfragebogen Hannover zur alltagsnahen Diagnostik der Funktionsbeeinträchtigung durch Rückenschmerzen (FFbH-R). Rehabilitation 1996; 35 (1) 1-8
    Google Scholar
  • 26 Lamb SE, Hansen Z, Lall R , et al. Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. Published online http://www.thelancet.com February 26, 2010; the version is existing in Lancet 2010 Mar 13;375(9718):916–923. Epub 2010 Feb 25
    PubMedGoogle Scholar
  • 27 Lin L-Y, Wang R-H. Abdominal surgery, pain and anxiety: Pre-operative nursing intervention. J Adv Nurs 2005; 51 (3) 252-260
    CrossrefPubMedGoogle Scholar
  • 28 Liossi C, White P, Hatira P. A randomized clinical trial of a brief hypnosis intervention to control venepuncture-related pain of paediatric cancer patients. Pain 2009; 142: 255-263
    CrossrefPubMedGoogle Scholar
  • 29 Moerman DE. The meaning response. Thinking about placebos. Pain Pract 2006; 6 (4) 233-236
    CrossrefPubMedGoogle Scholar
  • 30 Molton IR, Jensen MP, Nielson W , et al. A preliminary evaluation of the motivational model of pain self-management in persons with spinal cord injury-related pain. J Pain 2008; 9 (7) 606-612
    CrossrefPubMedGoogle Scholar
  • 31 Montgomery GH, David D, Winkel G , et al. The effectiveness of adjunctive hypnosis with surgical patients: A meta-analysis. Anesth Analg 2002; 94: 1639-1645
    PubMedGoogle Scholar
  • 32 Nagel B, Gerbershagen HU, Lindena G , et al. Entwicklung und empirische Überprüfung des Deutschen Schmerzfragebogens der DGSS. Schmerz 2002; 16: 263-270
    CrossrefPubMedGoogle Scholar
  • 33 Narsavage GL. Promoting function in clients with chronic lung disease by increasing their perception of control. Holistic Nurs Pract 1997; 12 (1) 17-26
    PubMedGoogle Scholar
  • 34 Nicholas MK, Wilson PH, Goyen J. Comparison of cognitive-behavioral group treatment and an alternative non-psychological treatment for chronic low back pain. Pain 1992; 48: 339-347
    CrossrefPubMedGoogle Scholar
  • 35 Oettingen G. Positive fantasy and motivation. In: Gollwitzer PM, Bargh JA, eds. The Psychology of Action: Linking Cognition and Motivation to Behavior. New York: Guilford Press; 1996: 236-259
    Google Scholar
  • 36 Pfingsten M, Kröner-Herwig B, Leibing E , et al. Validation of the German version of the Fear-Avoidance Beliefs Questionnaire (FABQ). Eur J Pain 2000; 4 (3) 259-266
    CrossrefPubMedGoogle Scholar
  • 37 Pfingsten M, Nagel B, Emrich O , et al. Deutscher Schmerz-Fragebogen. Handbuch, Internet. http://www.dgss.org/index.php?id=16 November 18, 2008, 2007
    PubMedGoogle Scholar
  • 38 Price DD, Finniss DG, Benedetti F. A comprehensive review of the placebo effect: Recent advances and current thought. Annu Rev Psychol 2008; 59: 565-590
    CrossrefPubMedGoogle Scholar
  • 39 Rasch B, Friese M, Hofmann WJ , et al. Quantitative Methoden 2. Berlin: Springer Verlag; 2006
    Google Scholar
  • 40 Rose MJ, Reilly JP, Pennie B , et al. Chronic low back pain rehabilitation programs: A study of the optimum duration of treatment and a comparison of group and individual therapy. Spine 1997; 22 (19) 2246-2253
    CrossrefPubMedGoogle Scholar
  • 41 Schramm S. Ein dynamischer Ansatz zur Steigerung der Veränderungs­motivation von chronischen Rückenschmerzpatienten. Doctoral Thesis: Hamburg University; 2005
    Google Scholar
  • 42 Shuldham C. A review of the impact of pre-operative education on recovery from surgery. Int J Numer Model El 1999; 36: 171-177
    PubMedGoogle Scholar
  • 43 Sinikallio S, Aalto T, Lehto SM , et al. Depressive symptoms predict postoperative disability among patients with lumbar spinal stenosis: A two-year prospective study comparing two age groups. Disabil Rehabil 2009;
    PubMedGoogle Scholar
  • 44 Sommer M, Geurts JWJM, Stessel B , et al. Prevalence and predictors of postoperative pain after ear, nose, and throat surgery. Arch Otolaryngol 2009; 135 (2) 124-130
    CrossrefPubMedGoogle Scholar
  • 45 Syrjala KL, Donaldson GW, Davis MW , et al. Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: A controlled clinical trial. Pain 1995; 63: 189-198
    CrossrefPubMedGoogle Scholar
  • 46 Turk DC, Dworkin RH, McDermott MP , et al. Analyzing multiple endpoints in clinical trials of pain treatments: IMMPACT recommendations. Pain 2008; 139: 485-493
    CrossrefPubMedGoogle Scholar
  • 47 Turk DC, Swanson KS, Tunks ER. Psychological approaches in the treatment of chronic pain patients – when pills, scalpels, and needles are not enough. Can J Psychiat 2008; 53 (4) 213-223
    PubMedGoogle Scholar
  • 48 Turner JA. Comparison of group progressive-relaxation training and cognitive-behavioral group therapy for chronic low back pain. J Consult Clin Psych 1982; 50 (5) 757-765
    CrossrefPubMedGoogle Scholar
  • 49 Turner JA, Ersek M, Kemp C. Self-efficacy for managing pain is associated with disability, depression, and pain coping among retirement community residents with chronic pain. J Pain 2005; 6 (7) 471-479
    CrossrefPubMedGoogle Scholar
  • 50 Waddell G, Newton M, Henderson I , et al. A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993; 52: 157-168
    CrossrefPubMedGoogle Scholar
  • 51 Woods MP, Asmundson GJG. Evaluating the efficacy of graded in vivo exposure for the treatment of fear in patients with chronic pain: A randomized controlled clinical trial. Pain 2008; 136: 271-280
    CrossrefPubMedGoogle Scholar
  • 52 Zieger M, Schwarz R, König HH , et al. Depression and anxiety in patients undergoing herniated disc surgery: Relevant but underresearched – A systematic review. Cen Eur Neurosurg 2010; 71 (1) 26-34
    Article in Thieme ConnectPubMedGoogle Scholar