Department of Psychology, Washington DC Veterans Affairs Medical Center, Washington, DC, USA Department of Psychology, Loyola University Maryland, Baltimore, Maryland, USA Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, Maryland, USA Department of Biostatistics, Vanderbilt University, School of Medicine, Nashville, Tennessee, USA Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University, School of Medicine, Nashville, Tennessee, USA.
Pain. 2012 Mar;153(3):518-525. doi: 10.1016/j.pain.2011.10.012. Epub 2011 Nov 25.
Consistent evidence supports a significant association between lower positive affect and higher negative affect and increased pain and disability in adults with chronic pain. However, examining this relation in surgical populations has received little empirical consideration. The primary purpose of this study was to determine whether preoperative and postoperative positive and negative affect predict pain, disability, and functional status after spine surgery. A secondary objective was to assess the relation of depression to postoperative outcomes compared with positive and negative affect. Participants were 141 patients treated by spine surgery for lumbar or cervical degeneration. Data collection occurred at baseline and 6 weeks and 3 months postoperatively. Affect was measured with the Positive and Negative Affect Schedule. Multivariable mixed-model linear regression analyses found that preoperative variables were not predictive of postoperative pain, disability and functional status. However, multivariable postoperative analysis found that 6-week positive affect predicted functional status, and 6-week negative affect predicted pain interference and pain-related disability at 3 months following surgery. Postoperative depression demonstrated statistically significant and stronger associations with pain intensity, pain interference, and pain-related disability at 3-month follow-up, as compared with negative affect. Results suggest that positive affect and depression are important variables to target when seeking to improve postoperative outcomes in a spine surgery population. Recommendations include postoperative screening for positive affect and depression, and treating depression as well as focusing on rehabilitation strategies to bolster positive affect so as to improve functional outcomes after spine surgery.
有充分的证据表明，慢性疼痛患者的积极情绪较低和消极情绪较高与疼痛加剧和残疾程度增加之间存在显著关联。然而，对于手术人群中的这种关系，实证研究关注甚少。本研究的主要目的是确定术前和术后的积极情绪和消极情绪是否可以预测脊柱手术后的疼痛、残疾和功能状态。次要目的是评估与积极情绪和消极情绪相比，抑郁与术后结果的关系。参与者为 141 名因腰椎或颈椎退变接受脊柱手术治疗的患者。数据收集在基线、术后 6 周和 3 个月进行。使用正性和负性情绪量表测量情绪。多变量混合模型线性回归分析发现，术前变量不能预测术后疼痛、残疾和功能状态。然而，多变量术后分析发现，6 周时的积极情绪可以预测 3 个月时的功能状态，6 周时的消极情绪可以预测 3 个月时的疼痛干扰和与疼痛相关的残疾。与消极情绪相比，术后抑郁与术后 3 个月的疼痛强度、疼痛干扰和与疼痛相关的残疾具有更强的统计学显著关联。结果表明，在寻求改善脊柱手术人群术后结果时，积极情绪和抑郁是需要关注的重要变量。建议包括对术后积极情绪和抑郁进行筛查，并治疗抑郁，以及关注康复策略以增强积极情绪，从而改善脊柱手术后的功能结果。
