The role of sensory parameters in predicting clinical outcome after lumbar discectomy
The role of quantitative sensory testing parameters in predicting clinical outcome in patients undergoing lumbar discectomy
Dr Brigitte Tampin
160 participants
Sep 30, 2014
Observational
Conditions
Summary
Low back pain is one of the most common health problems and affects 80 – 85% of people over their life time. Health costs due to back problems in Australia were estimated to be $4.79 million in 2012. Low back-related leg pain or sciatica is a common variation of low back pain and may require back surgery. Thirty percent of people report persistent pain after back surgery which is associated with disability, reduced quality of life, reduced work capacity and substantial health care costs. Whilst several risk factors have been identified (e.g. psychological factors such as catastrophising, unhelpful beliefs about pain and disability) for poor outcome after surgery, the role of pre-sensory pain sensitivity is unknown. Research suggests that certain people who demonstrate hypersensitivity to sensory stimuli such as hot/cold, touch and pressure, pin-prick and vibration may be more vulnerable to develop ongoing pain, however this has not yet been explored in people with back and leg pain. This study will investigate if pre-surgical responses to these stimuli may play a role in predicting persistent pain after back surgery. The findings may assist in developing pre-surgical screening methods and in using this outcome to target pre- and/or post-operative patient care, with the potential to improve patients’ functional status, quality of life, work capacity whilst also reducing health care costs associated with persistent disability.
Eligibility
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Interventions
The initial participant assessment will be performed in the week prior to surgery. The once-off baseline assessment will take approximately 2.5 hours. Standardised quantitative sensory testing (QST) will be performed according to the QST protocol of German Research Network on Neuropathic pain. The protocol includes the following assessments: cold and warm detection thresholds; the number of paradoxical heat sensations during the procedure of alternating warm and cold stimuli; cold and heat pain thresholds; mechanical detection threshold; mechanical pain threshold; stimulus-response functions: mechanical pain sensitivity and dynamic mechanical allodynia; wind-up ratio; vibration detection threshold and pressure pain threshold. QST measurements will be taken from the main pain area nominated by the patient, as required for the assessment of neuropathic pain, and the contralateral side and from the ipsilateral hand dorsum as a remote control site, plus thermal and mechanical detection thresholds will be assessed in the relevant dermatomes (L5 or S1). Testing of the full QST protocol will take approximately 30 minutes per test area. Testing of the dermatomal detection thresholds will take less than 10 minutes. In addition the following measurements will be taken either in interview format or via questionnaires at the initial assessment before surgery: *Duration of pain *Pain intensity of back and leg pain *Health care utilisation *Bothersomeness of back and leg pain *Confidence in recovery (‘great deal’, ‘moderate’, ‘no confidence’, ‘do not know’) *Intake of medication *Sleep quality (Visual Analogue Scale) *Duration of inability to work *Functional status (Oswestry Disability Index) *Anxiety and Depression (Hospital Anxiety and Depression Scale) *Pain descriptors (painDETECT) *Fear avoidance behaviour (Tampa Scale for Kinesiophobia) *Pain catastrophizing (Pain catastrophizing Scale) *Health-related quality of life (Short form-36 health questionnaire) *Risk assessment for persistent pain (Orebro Musculoskeletal Screening Questionnaire) Participants will be observed up to 12 months after surgery. The 3 months post-surgery assessment will include the full QST protocol just in the participants' previous maximal pain area and the reassessment of detection thresholds in the relevant dermatome. The QST assessment will take approx. 40 minutes. In addition participants will have to complete questionnaires.
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ACTRN12614001070628