Wakaizumi Kenta, Wu Binbin, Huang Shishi, Fan Linyu, Shen Bangli, Wu Bo, Zhang Jing, Baliki Marwan N, Apkarian A Vania, Huang Lejian
Shirley Ryan AbilityLab, Chicago, IL, USA.
Department of Physical Management and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Pain Rep. 2021 Mar 17;6(1):e906. doi: 10.1097/PR9.0000000000000906. eCollection 2021.
Lumbar disc herniation (LDH) is a common back disorder that evokes back and/or leg pain. Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgery for patients with LDH. However, there is little evidence of effectiveness of PELD compared with conservative treatments.
The goal of this study was to quantify the efficacy of PELD compared with conservative treatments.
Here, we conducted a prospective observational cohort study using momentary pain assessments via a smartphone app during 3 months following surgery. The trajectories of daily ecological momentary pain assessments were fitted with an exponential model containing two parameters: a pain reduction coefficient and the percentage of persistent pain. To control for selection bias between PELD and Conservative groups (N = 167 and 34), we used inverse probability (IP) of treatment weighting for statistical comparisons.
Compared with conservative treatments, both momentary pain rating and the exponential model showed statistically significant pain recovery following PELD (p < 0.001). In addition, PELD had a faster pain recovery rate (hazard ratio (95% confidence interval): 1.75 (1.40, 2.20), p < 0.001), greater overall pain recovery rate (odds ratio (95%CI): 2.35 (2.01, 5.26), p < 0.001), faster pain reduction (t = 3.32, p = 0.001), and lower estimated persistent pain (Z = 2.53, p = 0.011). Greater pain intensity and lower anxiety before the surgery were predictors of faster pain reduction in the recovery subgroup following PELD.
In conclusion, momentary pain rating and the model fitting revealed that PELD provided rapid pain recovery that lasted for at least three months. Greater pain intensity and lower anxiety before the surgery were predictors of faster pain reduction in the recovery subgroup following PELD. Daily momentary pain rating on a smartphone may be able to provide more informative data to evaluate effect of an intervention than pain assessment on hospital visits.
腰椎间盘突出症（LDH）是一种常见的背部疾病，会引起背部和/或腿部疼痛。经皮内镜下腰椎间盘切除术（PELD）是针对LDH患者的一种微创手术。然而，与保守治疗相比，PELD有效性的证据很少。
本研究的目的是量化PELD与保守治疗相比的疗效。
在此，我们进行了一项前瞻性观察队列研究，在手术后3个月内通过智能手机应用程序进行即时疼痛评估。每日生态即时疼痛评估的轨迹采用包含两个参数的指数模型进行拟合：疼痛减轻系数和持续性疼痛百分比。为了控制PELD组和保守治疗组（N = 167和34）之间的选择偏倚，我们使用治疗权重的逆概率（IP）进行统计比较。
与保守治疗相比，即时疼痛评分和指数模型均显示PELD术后疼痛恢复具有统计学意义（p < 0.001）。此外，PELD的疼痛恢复速度更快（风险比（95%置信区间）：1.75（1.40，2.20），p < 0.001），总体疼痛恢复率更高（优势比（95%CI）：2.35（2.01，5.26），p < 0.001），疼痛减轻更快（t = 3.32，p = 0.001），估计的持续性疼痛更低（Z = 2.53，p = 0.011）。术前疼痛强度更大和焦虑程度更低是PELD术后恢复亚组中疼痛减轻更快的预测因素。
总之，即时疼痛评分和模型拟合表明，PELD能实现快速的疼痛恢复，且至少持续三个月。术前疼痛强度更大和焦虑程度更低是PELD术后恢复亚组中疼痛减轻更快的预测因素。与在医院就诊时的疼痛评估相比，通过智能手机进行的每日即时疼痛评分可能能够提供更多信息性数据来评估干预效果。
