Evaluating the Impact of Psychiatric Disorders on Preoperative Pain Ratings, Narcotics Use, and the PROMIS-29 Quality Domains in Spine Surgery Candidates

Abstract

We aimed to study the relationship between psychiatric Disorders (PD), preoperative pain, and opioid medication intake, as well as the quality of life patient-reported outcome measures using the Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) questionnaire, during the 30-day interval preceding surgery, in a consecutive series of patients who were scheduled to undergo surgical spine procedures. We hypothesized that PD could affect preoperative narcotic use and pain interference in a fashion that was not linearly associated with preoperative pain in spine surgery candidates. MethodsThe records of consecutive adult patients who underwent elective spinal surgery between October 2016 and August 2017 at a single institution were reviewed. We included patients who underwent preoperative pain assessment within 30 days prior to their planned surgery using the PROMIS-29 questionnaire. Patients with PD were compared to controls. ResultsA total of 117 patients matched our criteria. The average rating of pain intensity was notably higher in the PD group as compared to controls (p=0.004). The PD group had more patients complaining of high pain levels (>6) as compared to the control group (p=0.026). Controls with high pain levels had a greater incidence of preoperative narcotic use as compared to the low-pain cohort (p=0.029). However, there was no difference in the actual dose of daily narcotic medication taken between the PD and control groups (P=0.099) or between the low-and high pain score groups in the control (p=0.291) and PD (p=0.441) groups, respectively. Patients with PD and higher pain ratings seemed to have a higher incidence of anxiety (p=0.005) and depression (p<0.001). That was not the case for controls. ConclusionsPDs may impact the degree of preoperative pain interference and the intake of narcotic medication independently from pain intensity ratings.

Are We Considering the Whole Patient? The Impact of Physical and Mental Health on the Outcomes of Spine Care

“…23 In clinical studies of spine surgery patients, baseline PROMIS scores across various domains have been shown to be associated with postoperative patient-reported outcomes (PROs), [24][25][26][27] pain, 27,28 patient satisfaction, 29 and opioid use. 27,28 The PROMIS global health (PROMIS-GH) measure, also referred to as the PROMIS-10, includes 10 questions evaluating the domains of physical health (PH) and mental health (MH). 30 The resulting PH and MH t-scores are normalized to a population mean of 50 and SD of 10.…”

“…17,22,23 However, potentially because of the relatively new nature of the PROMIS instruments, the majority of studies have focused on evaluating its validity rather than using it as an outcome measure, as was originally intended by the developers. 23 In clinical studies of spine surgery patients, baseline PROMIS scores across various domains have been shown to be associated with postoperative patient-reported outcomes (PROs), [24][25][26][27] pain, 27,28 patient satisfaction, 29 and opioid use. 27,28 The PROMIS global health (PROMIS-GH) measure, also referred to as the PROMIS-10, includes 10 questions evaluating the domains of physical health (PH) and mental health (MH).…”