Anxiety and depression affect pain drawings in cervical degenerative disc disease

Figures & data

Table 1. Demographics at baseline.

Patient characteristics	Total n
Age, years, median (min–max)	130	46 (31–61)
Women/men, n	130	67/63
Smokers, n (%)	130	39 (30)
Non-smokers, n (%)	130	91 (70)
In work, n (%)	128	111 (87)
Not in work, n (%)	128	17 (13)
High-HADS, n (%)	129	39 (30)
Low-HADS, n (%)	129	90 (70)
High-VAS-neck, n (%)	127	55 (43)
Low-VAS-neck, n (%)	127	72 (57)
High-VAS-arm, n (%)	128	48 (38)
Low-VAS-arm, n (%)	128	80 (63)

High-HADS ≥10 points; Low-HADS <10 points; High-VAS ≥67; Low-VAS <67.

Table 2. Principles of dichotomization of the various methods.

Method	Neurogenic	Non-neurogenic
Ransford (penalty points)	0–2	3+
Udén	N, PN	NN, PNN
Gatchel (ticked boxes, n)	0–19	20+

Table 3. Results from predictor analysis. Entries are odds ratio, OR (95% CI) P.

Method	Age: yearsOR (95% CI) P	Gender: male versus femaleOR (95% CI) P	SmokingOR (95% CI) P	EmploymentOR (95% CI) P
Ransford	0.99 (0.94, 1.04) 0.62	1.30 (0.65, 2.60) 0.46	1.97 (0.92, 4.23) 0.81	0.99 (0.36, 2.75) 0.99
Udén	0.98 (0.91, 1.06) 0.63	1.68 (0.61, 4.57) 0.31	2.57 (0.88, 7.47) 0.084	0.56 (0.14, 2.24) 0.41
Gatchel	0.83 (0.66, 1.06) 0.14	0.41 (0.01, 12.53) 0.61	24.29 (0.65, 903.88) 0.084	0.33 (0.00, 25.08) 0.62

Table 4. HADS per method result for the totality of all observers. Entries are median (min, max).

Method	Mean no. of patients	HADS-d Median (min, max)	HADS-a Median (min, max)	HADS-t Median (min, max)
Ransford
Neurogenic	64.5	4 (0, 13)	6 (0,16)	10 (0, 29)
Non-neurogenic	65.5	5 (0, 16)	7 (1, 16)	13 (1, 29)
Udén
Neurogenic	93.75	4 (0, 16)	7 (0, 16)	10 (0, 29)
Non-neurogenic	36.25	5 (0, 16)	7 (1, 16)	13 (1, 29)
Gatchel
Neurogenic	58	4 (0, 13)	6 (0, 16)	10 (0, 29)
Non-neurogenic	72	5 (0, 16)	7 (0, 16)	13 (1, 29)
Ohnmeiss
Head
0	101.75	4 (0, 13)	7 (0, 16)	10 (0, 29)
1	28.25	7 (0, 16)	7 (1, 16)	15 (1, 29)
Neck
0	26	4 (0, 12)	7 (1, 16)	10 (1, 27)
1	104	5 (0, 16)	7 (0, 16)	12 (0, 29)
Shoulder
0	6	4 (0, 16)	8 (2, 13)	10 (2, 29)
1	124	4 (0, 16)	7 (0, 16)	11 (0, 29)
Upper arm
0	12	4 (0, 12)	7 (1, 15)	13 (2, 27)
1	118	4 (0, 16)	7 (0, 16)	11 (0, 29)
Lower arm
0	4.25	2 (0, 9)	5 (2, 14)	6 (2, 23)
1	125.75	4 (0, 16)	7 (0, 16)	12 (0, 29)
Bilateral markings
0	98.25	4 (0, 16)	7 (0, 16)	11 (0, 29)
1	31.75	5 (0, 13)	7 (1, 16)	10 (1, 27)

Table 5. Results from method comparison. Entries are difference in means (95% CI) P value. The values are: The mean difference between HADS-d in group N and NN, group 1 and 0; The mean difference between HADS-a in group N and group NN, group 1 and group 0; The mean difference between HADS-t in group N and NN, group 1 and 0.

Method	HADS-d Mean diff. (95% CI) P	HADS-a Mean diff. (95% CI) P	HADS-t Mean diff. (95% CI) P
Ransford	1.0 (0.1, 1.9) 0.030	1.0 (0.0, 2.0) 0.046	2.0 (0.3, 3.8) 0.021
Udén	0.5 (–0.4, 1.4) 0.26	0.1 (–1.0, 1.2) 0.86	0.6 (–1.2, 2.5) 0.52
Gatchel	1.1 (–0.1, 2.2) 0.064	0.9 (–0.4, 2.2) 0.19	1.9 (–0.3, 4.1) 0.088
Ohnmeiss
Head	1.7 (0.1, 3.2) 0.037	1.2 (–0.6, 3.0) 0.17	2.9 (–0.1, 5.9) 0.062
Neck	0.9 (–0.5, 2.3) 0.20	0.0 (–1.7, 1.7) 0.96	0.9 (–1.8, 3.6) 0.49
Shoulder	0.1 (–4.3, 3.4) 0.97	–0.3 (–2.9, 2.7) 0.84	–0.2 (–6.9, 5.8) 0.95
Upper arm	0.6 (–1.5, 2.4) 0.54	–0.4 (–2.7, 1.9) 0.74	0.2 (–3.9, 4.0) 0.91
Lower arm	1.7 (–2.2, 4.6) 0.33	0.5 (–6.2, 4.4) 0.83	2.3 (–8.4, 8.5) 0.61
Bilateral	0.2 (–1.2, 1.5) 0.82	0.1 (–1.6, 1.9) 0.90	0.3 (–2.6, 3.1) 0.85

Difference in means presented for each method. The endpoint mean for the N group is subtracted from the endpoint mean in the NN group. For the modified Ohnmeiss method, the endpoint mean for the group 0 (no markings) was subtracted from the endpoint mean in group 1 (with markings). Hence positive values correspond to larger values on HADS for the NN group or (for Ohnmeiss) for group 1.

Table 6. Analysis of dichotomized HADS and dichotomized preoperative VAS-neck and VAS-arm. The numerator was the odds for high-HADS and high-VAS, respectively, which means that OR > 1 favours the associations between the NN pain drawings (for the modified Ohnmeiss method, group 1, with markings) and high-HADS, high-VAS.

Method	HADS OR (95% CI) P	VAS-neck OR (95% CI) P	VAS-arm OR (95% CI) P
Ransford	1.68 (1.06, 2.66) 0.026	1.13 (0.74, 1.73) 0.60	0.84 (0.54, 1.29) 0.46
Udén	0.92 (0.54, 1.54) 0.80	0.90 (0.56, 1.46) 0.73	0.91 (0.55, 1.48) 0.72
Gatchel	1.21 (0.76, 1.92) 0.44	1.32 (0.86, 2.02) 0.21	1.46 (0.94, 2.27) 0.091
Ohnmeiss
Head	2.34 (1.36, 4.03) 0.001	1.45 (0.86, 2.46) 0.16	0.67 (0.38, 1.17) 0.15
Neck	0.92 (0.52, 1.67) 0.78	2.56 (1.41, 4.79) < 0.001	0.53 (0.31, 0.90) 0.017
Shoulder	1.13 (0.37, 4.16) 1.00	0.75 (0.26, 2.20) 0.63	1.21 (0.41, 4.02) 0.81
Upper arm	1.03 (0.47, 2.39) 1.00	0.79 (0.38, 1.65) 0.49	1.28 (0.59, 2.89) 0.59
Lower arm	0.97 (0.27, 4.42) 1.00	2.62 (0.66, 15.03) 0.16	∞ (1.89, ∞) 0.003
Bilateral	1.01 (0.58, 1.73) 1.00	0.77 (0.46, 1.28) 0.33	0.93 (0.55, 1.56) 0.81

CI = confidence interval; HADS = Hospital Anxiety and Depression Scale; OR = odds ratio; P = P value; VAS = visual analogue scale.