“…A subsequent selection step involved reading full text articles and removing those not meeting our selection criteria (n = 212) which resulted in the final inclusion of 36 studies ( Figure 1 ). 17–52 A detailed list of all included reviews can be found in Supplementary Table 2 ( Supplementary Table 2: List of 36 included reviews ). Figure 1 PRISMA flow diagram.…”
Section: Resultsmentioning
confidence: 99%
“…Interestingly, one review found that in lumbar spine surgery, preoperative leg pain had a reverse predictive effect, in that patients with more pain at a separate site had a lower risk of CPSP. 17 In this case, leg pain may be considered as a referred pain, and spinal fusion might be the optimal surgery for this type of pain, which could explain the negative association between pain at other sites as a risk factor and CPSP. It is also possible that patients starting with a higher symptom burden had overall more relief from surgery or, alternatively, that these patients had been conditioned to tolerate higher levels of pain, so their development of CPSP might have been lower.…”
Section: Discussionmentioning
confidence: 99%
“…There is inconsistency between primary studies in outcome reporting, including the lack of reporting on confounding factors. 17 , 36 , 42 Reviews reported an overall low study quality, partly due to the inclusion of primary studies with poor study designs, leading to insufficient results rather than robust studies with strong statistical methodologies that enable comprehensive and effective data analysis and interpretation. 31 , 36 There were significant differences in sample sizes among primary studies, with a small sample size leading to a potential overestimation of predictors.…”
Purpose
Risk factors for the development of chronic postsurgical pain (CPSP) have been reported in primary studies and an increasing number of reviews. The objective of this umbrella review was to compile and understand the published presurgical risk factors associated with the development of CPSP for various surgery types.
Methods
Six databases were searched from January 2000 to June 2023 to identify meta-analyses, scoping studies, and systematic reviews investigating presurgical CPSP predictors in adult patients. Articles were screened by title/abstract and subsequently by full text by two independent reviewers. The selected papers were appraised for their scientific quality and validity. Data were extracted and descriptively analyzed.
Results
Of the 2344 retrieved articles, 36 reviews were selected for in-depth scrutiny. The number of primary studies in these reviews ranged from 4 to 317. The surgery types assessed were arthroplasty (n = 13), spine surgery (n = 8), breast surgery (n = 4), shoulder surgery (n = 2), thoracic surgery (n = 2), and carpal tunnel syndrome (n = 1). One review included a range of orthopedic surgeries; six reviews included a variety of surgeries. A total of 39 presurgical risk factors were identified, some of which shared the same defining tool. Risk factors were themed into six broad categories: psychological, pain-related, health-related, social/lifestyle-related, demographic, and genetic. The strength of evidence for risk factors was inconsistent across different reviews and, in some cases, conflicting. A consistently high level of evidence was found for preoperative pain, depression, anxiety, and pain catastrophizing.
Conclusion
This umbrella review identified a large number of presurgical risk factors which have been suggested to be associated with the development of CPSP after various surgeries. The identification of presurgical risk factors is crucial for the development of screening tools to predict CPSP. Our findings will aid in designing screening tools to better identify patients at risk of developing CPSP and inform strategies for prevention and treatment.
“…A subsequent selection step involved reading full text articles and removing those not meeting our selection criteria (n = 212) which resulted in the final inclusion of 36 studies ( Figure 1 ). 17–52 A detailed list of all included reviews can be found in Supplementary Table 2 ( Supplementary Table 2: List of 36 included reviews ). Figure 1 PRISMA flow diagram.…”
Section: Resultsmentioning
confidence: 99%
“…Interestingly, one review found that in lumbar spine surgery, preoperative leg pain had a reverse predictive effect, in that patients with more pain at a separate site had a lower risk of CPSP. 17 In this case, leg pain may be considered as a referred pain, and spinal fusion might be the optimal surgery for this type of pain, which could explain the negative association between pain at other sites as a risk factor and CPSP. It is also possible that patients starting with a higher symptom burden had overall more relief from surgery or, alternatively, that these patients had been conditioned to tolerate higher levels of pain, so their development of CPSP might have been lower.…”
Section: Discussionmentioning
confidence: 99%
“…There is inconsistency between primary studies in outcome reporting, including the lack of reporting on confounding factors. 17 , 36 , 42 Reviews reported an overall low study quality, partly due to the inclusion of primary studies with poor study designs, leading to insufficient results rather than robust studies with strong statistical methodologies that enable comprehensive and effective data analysis and interpretation. 31 , 36 There were significant differences in sample sizes among primary studies, with a small sample size leading to a potential overestimation of predictors.…”
Purpose
Risk factors for the development of chronic postsurgical pain (CPSP) have been reported in primary studies and an increasing number of reviews. The objective of this umbrella review was to compile and understand the published presurgical risk factors associated with the development of CPSP for various surgery types.
Methods
Six databases were searched from January 2000 to June 2023 to identify meta-analyses, scoping studies, and systematic reviews investigating presurgical CPSP predictors in adult patients. Articles were screened by title/abstract and subsequently by full text by two independent reviewers. The selected papers were appraised for their scientific quality and validity. Data were extracted and descriptively analyzed.
Results
Of the 2344 retrieved articles, 36 reviews were selected for in-depth scrutiny. The number of primary studies in these reviews ranged from 4 to 317. The surgery types assessed were arthroplasty (n = 13), spine surgery (n = 8), breast surgery (n = 4), shoulder surgery (n = 2), thoracic surgery (n = 2), and carpal tunnel syndrome (n = 1). One review included a range of orthopedic surgeries; six reviews included a variety of surgeries. A total of 39 presurgical risk factors were identified, some of which shared the same defining tool. Risk factors were themed into six broad categories: psychological, pain-related, health-related, social/lifestyle-related, demographic, and genetic. The strength of evidence for risk factors was inconsistent across different reviews and, in some cases, conflicting. A consistently high level of evidence was found for preoperative pain, depression, anxiety, and pain catastrophizing.
Conclusion
This umbrella review identified a large number of presurgical risk factors which have been suggested to be associated with the development of CPSP after various surgeries. The identification of presurgical risk factors is crucial for the development of screening tools to predict CPSP. Our findings will aid in designing screening tools to better identify patients at risk of developing CPSP and inform strategies for prevention and treatment.
“…In this study, we evaluated the efficacy of TSCP by focusing on whether the patient underwent open revision surgery after TSCP. As in previous reports ( 29 , 30 ), we considered including duration of symptoms and severity of preoperative leg and back pain as prognostic factors but were unable to do so owing to lack of sufficient data. We consider this to be a limitation of this study.…”
Trans-sacral canal plasty (TSCP) is a minimally invasive lumbar spine surgery under local anaesthesia. TSCP is expected to be effective regardless of whether the patient has had previous surgery. However, there are cases in which open revision surgery is required after TSCP. This study aimed to identify risk factors for open revision surgery after TSCP in order to determine surgical indications and limitations. A retrospective case-control study was conducted in patients who underwent TSCP for lumbar spine disease. Data of 112 patients were analysed. During an observation period of 7–23 months, 34 patients (30.4%) required open revision surgery and 78 (69.6%) did not. The following patient background characteristics were investigated: age, sex, body mass index (BMI), diagnosis, history of spine surgery and the institution where the surgery was performed. Comorbidities were scored using the Elixhauser Comorbidity Index. Preoperative imaging parameters were investigated, including the lesion level (L4/5, L5/S1, other), presence of intervertebral instability, dural sac area, presence of bony stenosis and presence of epidural lipoma. Multivariate analysis revealed that intervertebral instability (odds ratio 2.56, confidence interval 1.00–6.51, p = 0.046) and a narrow dural sac area (odds ratio 0.98, confidence interval 0.97–0.99, p = 0.002) were significant risk factors for open revision surgery after TSCP.
“…For non-radicular back pain associated with degenerative spinal conditions, the benefits of spinal fusion were not superior to those of nonoperative treatment [ 32 ]. Previous evidence suggests that patients with radicular pain may have better outcomes after spinal surgery and that preoperative working status may be a reliable indicator of surgical success [ 33 ].…”
Amid the worldwide increase in spinal surgery rates, a significant proportion of patients continue to experience refractory chronic pain, resulting in reduced quality of life and escalated healthcare demands. Failed back surgery syndrome (FBSS) is a clinical condition characterized by persistent or recurrent pain after one or more spinal surgeries. The diverse characteristics and stigmatizing descriptions of FBSS necessitate a reevaluation of its nomenclature to reflect its complexity more accurately. Accurate identification of the cause of FBSS is hampered by the complex nature of the syndrome and limitations of current diagnostic labels. Management requires a multidisciplinary approach that may include pharmacological treatment, physical therapy, psychological support, and interventional procedures, emphasizing realistic goal-setting and patient education. Further research is needed to increase our understanding, improve diagnostic accuracy, and develop more effective management strategies.
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