From the University Clinic of Anaesthesiology and Pain Medicine, Inselspital (MM, FT), Translational Research Centre, University Hospital of Psychiatry (MM), CTU Bern and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern (AL), Department of Radiology, Balgrist University Hospital, Zürich (CAA), Department of Orthopaedics, Private Clinic Sonnenhof (PH), University Clinic of Orthopaedics and Traumatology, Inselspital, Bern, Switzerland (US), Department of Health Science and Technology, Centre for Sensory-Motor Interaction, University of Aalborg, Aalborg, Denmark (OKA, LA-N, MC), Applied Health Research Centre (AHRC) of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (PJ), Institute of Primary Healthcare, University of Bern, Bern, Switzerland (PJ) and Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA (MC).
Eur J Anaesthesiol. 2019 Sep;36(9):695-704. doi: 10.1097/EJA.0000000000001012.
Failed back surgery syndrome (FBSS) is a pain condition refractory to therapy, and is characterised by persistent low back pain after spinal surgery. FBSS is associated with severe disability, low quality of life and high unemployment. We are currently unable to identify patients who are at risk of developing FBSS. Patients with chronic low back pain may display signs of central hypersensitivity as assessed by quantitative sensory tests (QST). This can contribute to the risk of developing persistent pain after surgery.
We tested the hypothesis that central hypersensitivity as assessed by QST predicts FBSS.
Prospective cohort study.
Three tertiary care centres.
141 patients scheduled for up to three segment spinal surgery for chronic low back pain (defined as at least 3 on a numerical rating scale on most days during the week and with a minimum duration of 3 months) due to degenerative changes.
We defined FBSS as persistent pain, persistent disability or a composite outcome defined as either persistent pain or disability. The primary outcome was persistent pain 12 months after surgery. We applied 14 QST using electrical, pressure and temperature stimulation to predict FBSS and assessed the association of QST with FBSS in multivariable analyses adjusted for sociodemographic, psychological and clinical and surgery-related characteristics.
None of the investigated 14 QST predicted FBSS, with 95% confidence intervals of crude and adjusted associations of all QST including one as a measure of no association. Results remained robust in all sensitivity and secondary analyses.
The study indicates that assessment of altered central pain processing using current QST is unlikely to identify patients at risk of FBSS and is therefore unlikely to inform clinical decisions.
失败性腰椎手术综合征（FBSS）是一种对治疗有抗性的疼痛病症，其特征是在脊柱手术后持续存在下腰痛。FBSS 与严重的残疾、生活质量低和高失业率有关。我们目前无法确定有发展为 FBSS 风险的患者。慢性腰痛患者可能表现出定量感觉测试（QST）评估的中枢敏化迹象。这可能会增加手术后持续疼痛的风险。
我们检验了 QST 评估的中枢敏化是否预测 FBSS 的假设。
前瞻性队列研究。
三个三级保健中心。
141 名因退行性改变而计划接受最多三节段脊柱手术治疗慢性腰痛（定义为每周大部分日子疼痛评分至少为 3 分，且疼痛持续至少 3 个月）的患者。
我们将 FBSS 定义为手术后 12 个月的持续疼痛、持续残疾或复合结局（定义为持续疼痛或残疾）。主要结局是手术后 12 个月的持续疼痛。我们使用电、压力和温度刺激进行了 14 项 QST 以预测 FBSS，并在调整了社会人口统计学、心理和临床及手术相关特征的多变量分析中评估了 QST 与 FBSS 的关联。
未发现任何一项研究的 14 项 QST 可预测 FBSS，所有 QST 的粗和调整关联的 95%置信区间均包括一个无关联的测量值。在所有敏感性和二次分析中，结果均保持稳健。
该研究表明，使用当前 QST 评估改变的中枢疼痛处理不太可能识别出有 FBSS 风险的患者，因此不太可能为临床决策提供信息。
