Coexistence of pain and depression predicts poor 2-year surgery outcome among lumbar spinal stenosis patients

Abstract

Background: Lumbar spinal stenosis is a common cause of back and leg pain with the most severe cases treated surgically. Regarding the surgery outcome, the importance of early postoperative depression and pain is unknown. Aims: To examine whether the coexistence of pain and depressive symptoms on 3-month follow-up predicts the 2-year surgery outcome. Methods: 93 patients (mean age 62 years) with symptomatic lumbar spinal stenosis underwent decompressive surgery. They completed the same set of questionnaires, 3 months, 1 year and 2 years postoperatively. Depression was assessed with the 21-item Beck Depression Inventory (BDI). Physical functioning and pain were assessed with the Oswestry Disability Index, the Stucki Questionnaire, self-reported walking ability, the visual analogue scale (VAS) and pain drawing. Comparisons were made between groups according to the “misery” (i.e. the coexistence of elevated pain and depression on 3-month follow-up) status. Logistic regression analysis was used to examine the factors independently associated with a poor surgery outcome on 2-year follow-up. Results: The patients in the misery group (n=24) showed greater symptom severity and greater disability than the patients in the non-misery group (n=69) at all follow-up stages. No clinical improvement was seen in the misery group during the follow-up. An independent association was observed between belonging to the misery group and 2-year disability, symptom severity and poor walking capacity. Conclusions. Even moderately increased VAS and BDI scores, when presenting simultaneously on an individual patient level during the early postoperative period, imply a strong clinical burden and a risk factor for poor recovery. The assessment of pain and depressive symptoms is encouraged.

• Depression
• Lumbar spinal stenosis
• Outcome
• Pain
• Surgery

Acknowledgements

S. Sinikallio was supported by a Kuopio University Hospital EVO research grant and a research grant from the Signe and Ane Gyllenberg Foundation.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.