Categories Medical Research

Is Intensity of Low Back Pain Tied To Patients' Surgical Risk Tolerance?

This article in Pain Medicine News, from their April 2013 issue, cites the journal Spine (Spine 2013;38:140-147) in highlighting that when patients are in severe pain, they are more willing to accept the risks of surgery when they are not.  While the article does not suggest altering practice based on this study, it does mention one may want to provide a patient make with the information needed to make an informed decision, and rather than rushing for a decision when they are pain, letting them think about it when the pain subsides.

“We proved our main hypothesis: Increasing levels of pain are associated with increasing levels of risk tolerance,” Christopher M. Bono, MD, chief of the orthopedic spine service, Brigham and Women’s Hospital, and associate professor of orthopedic surgery, Harvard Medical School, both in Boston, told Pain Medicine News.”

Quoting directly from the Pain Medicine News Article:
…118 patients, enrolled from three hospitals, were being seen for the first time by a spine surgeon for a nontraumatic or non-neoplastic spinal disorder. Patients scored their level of LBP and leg pain on a continuous 10-point visual analog scale. The patients were presented with 24 flash cards showing surgical scenarios that varied in risk likelihood of three complications—nerve damage, wound infection and nonunion—and levels of surgical efficacy (success in relieving symptoms). Patients were asked to give a yes or no answer about whether they would be willing to have lumbar spine surgery based on each potential outcome.
The mean number of scenarios accepted by the patients was 10.2 (median, eight; standard deviation [SD], 8.5; range, 0-24, or 42.5% of the scenarios). Spearman rank correlation coefficients showed a moderate association between LBP intensity and acceptance of complication risks (r=0.37; P=0.0001). Leg pain intensity had a weak, positive correlation (r=0.19;P=0.04).
In bivariate analyses, a history of spinal injections was associated with patients’ acceptance of complication risks and willingness to undergo surgery (54.5% of scenarios accepted for those with a history of spinal injections vs. 27.6% for those without; P=0.0001). White patients were more willing to accept surgery (45.9% of scenarios) than nonwhite patients (28.4%; P=0.03). In multivariate analysis, LBP intensity was still a significant correlate (P=0.001) of the proportion of scenarios accepted, as was a history of spinal injections (P=0.001) and being white (0.03).

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