The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Patient-Reported Pain, Disability, Quality of Life, and Prescription Opioid Use in Lumbar Spine Degenerative Disease: Three- and Twelve-Month Results

Abstract

INTRODUCTION Prescription opioids negatively affect postoperative outcomes after lumbar spine surgery, and according to the CDC, the drug overdose epidemic has been exacerbated by the involvement of prescription medications. Thus, alternatives for pain control are imperative. Mindfulness-based stress reduction (MBSR) has been associated with improved activity, mood, walking, and work in opioid-using chronic pain patients. Prospective studies utilizing preoperative MBSR to impact postoperative outcomes in degenerative lumbar spine surgery are lacking. METHODS The intervention group underwent a preoperative online MBSR course. The comparison group was matched retrospectively in a 1:1 ratio by age, sex, type of surgery, and preoperative opioid use. A total of 3- and 12-mo postoperative patient-reported outcomes for pain, disability, quality of life, and prescription opioid use were compared. Univariate linear regression was used to assess if MBSR use was a significant predictor of outcomes. RESULTS At 3 mo, follow-up was 87.5% and 95.8% in the comparison and treatment groups, respectively. Mean ODI was significantly lower (P = .032), mean PROMIS-PF was significantly higher (P = .002), and mean PROMIS-PI was significantly lower (P = .025) in the treatment group. Also, change in mean PROMIS-PF and change in mean PROMIS-PI were significantly greater (P = .002, P = .038). MBSR use was a significant predictor of change in PROMIS-PF (P = .003). At 12 mo, follow-up was 58.3% and 83.3% in the comparison and treatment groups, respectively. Mean PROMIS-PI was significantly lower (P = .011) and change in mean PROMIS-PI was significantly greater (P = .003) in the treatment group. MBSR use was a significant predictor of change in PROMIS-PI (P = .004). CONCLUSION At 3 mo, the treatment group experienced significantly lower disability, higher physical function, and lower pain interference. At 12 mo, only lower pain interference persisted. Further clinical trials are needed to assess the effectiveness of preoperative MBSR on postoperative outcomes in lumbar spine surgery for degenerative disease.