High-impact chronic pain transition in surgical recipients with cervical spondylotic myelopathy

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  • 1 Department of Orthopaedics, Duke University, Durham, North Carolina;
  • | 2 Duke Clinical Research Institute, Duke University, Durham, North Carolina;
  • | 3 Department of Population Health Sciences, Durham, North Carolina;
  • | 4 Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina;
  • | 5 Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah;
  • | 6 Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;
  • | 7 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;
  • | 8 Department of Neurological Surgery, University of California, San Francisco, California;
  • | 9 PPG Atlanta Brain and Spine Care, Atlanta, Georgia;
  • | 10 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;
  • | 11 Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina;
  • | 12 Barrow Neurological Institute, Phoenix, Arizona; and
  • | 13 Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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OBJECTIVE

High-impact chronic pain (HICP) is a recently proposed metric that indicates the presence of a severe and troubling pain-related condition. Surgery for cervical spondylotic myelopathy (CSM) is designed to halt disease transition independent of chronic pain status. To date, the prevalence of HICP in individuals with CSM and their HICP transition from presurgery is unexplored. The authors sought to define HICP prevalence, transition, and outcomes in patients with CSM who underwent surgery and identify predictors of these HICP transition groups.

METHODS

CSM surgical recipients were categorized as HICP at presurgery and 3 months if they exhibited pain that lasted 6–12 months or longer with at least one major activity restriction. HICP transition groups were categorized and evaluated for outcomes. Multivariate multinomial modeling was used to predict HICP transition categorization.

RESULTS

A majority (56.1%) of individuals exhibited HICP preoperatively; this value declined to 15.9% at 3 months (71.6% reduction). The presence of HICP was also reflective of other self-reported outcomes at 3 and 12 months, as most demonstrated notable improvement. Higher severity in all categories of self-reported outcomes was related to a continued HICP condition at 3 months. Both social and biological factors predicted HICP translation, with social factors being predominant in transitioning to HICP (from none preoperatively).

CONCLUSIONS

Many individuals who received CSM surgery changed HICP status at 3 months. In a surgical population where decisions are based on disease progression, most of the changed status went from HICP preoperatively to none at 3 months. Both social and biological risk factors predicted HICP transition assignment.

ABBREVIATIONS

ASA = American Society of Anesthesiologists; CSM = cervical spondylotic myelopathy; HICP = high-impact chronic pain; mJOA = modified Japanese Orthopaedic Association; NDI = Neck Disability Index; QOD = Quality Outcomes Database; SES = socioeconomic status; VAS = visual analog scale.

Illustration from Kong et al. (pp 4–12). Copyright Qing-Jie Kong. Used with permission.

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