Preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy

[摘要] ENGLISH ABSTRACT: Background: On average one in three patients following lumbar surgery (LS) forradiculopathy experience persistent pain and disability following surgery. No perioperativetreatments have shown any ability to decrease this persistent pain and disability. In anotherchallenging low back pain (LBP) population, chronic LBP, pain education focusing on theneurobiology and neurophysiology of pain, has shown an ability to reduce reported pain anddisability. The purpose of this research study was to develop and test a preoperativeneuroscience education program for LS and determine its effect on pain and disabilityfollowing LS.Research Design and Methods: After a series of studies, a newly designed preoperativeneuroscience educational tool (PNET) was developed. Eligible patients scheduled for LS forradiculopathy participated in a multi-center study where they were randomized to eitherreceive usual care (preoperative education), or a combination of usual care plus one sessioncovering the content of the PNET, as delivered by a physiotherapist in a one-on-one verbalsession. Prior to LS, and one, three and six months after LS, 67 patients completed a seriesof self-report outcome measures consisting of LBP and leg pain rating (Numeric RatingScale), function (Oswestry Disability Index), fear avoidance (Fear Avoidance BeliefsQuestionnaire), pain catastrophization (Pain Catastrophization Scale), pain knowledge (PainNeurophysiology Questionnaire), various beliefs and experiences related to LS (LikertScale), and post-operative utilization of healthcare (Utilization of Healthcare Questionnaire).Results: At six month follow up there were no statistical difference (p <0.05) between theexperimental and control groups in regards to the primary outcome measures of function (p= 0.296), LBP (p = 0.077) and leg pain (p = 0.074). The experimental group scoredsignificantly better on various questions regarding beliefs and experiences having undergoneLS, compared to the control group indicating a more positive surgical experience. Analysis ofhealthcare utilization showed that patients who received the preoperative neuroscienceeducational program had dramatically less health care utilization (medical tests andtreatments) in the six months following LS (p = 0.001), resulting in a 38% savings inhealthcare cost.Conclusion: The addition of a preoperative neuroscience educational program to usual carefor LS for radiculopathy resulted in a profound behavioral change leading to a more positivesurgical experience, decreased healthcare utilization and resultant savings, despitepersistent pain and disability.

[发布机构] Stellenbosch University