Scottish Rite for Children, Dallas, Texas.
University of Texas Southwestern Medical Center, Dallas, Texas.
J Bone Joint Surg Am. 2022 Nov 2;104(21):1859-1868. doi: 10.2106/JBJS.22.00258. Epub 2022 Aug 18.
Patients with adolescent idiopathic scoliosis (AIS) often report chronic back pain; however, there is inadequate research on psychological factors associated with pain in this patient population. Pain catastrophizing, a psychological factor that describes a pattern of negative thoughts and feelings about pain, has been associated with poorer responses to medical treatment for pain. The purpose of this study was to report the prevalence of pain catastrophizing in the AIS population and assess its relationship with preoperative and postoperative self-reported outcomes.
In this prospective cohort study of consecutive patients undergoing posterior spinal fusion (PSF) for AIS, patients experiencing clinically relevant pain catastrophizing, defined as a Pain Catastrophizing Scale for Children (PCS) score in the 75th percentile or higher, were compared with patients with normal PCS scores. Preoperative and 2-year postoperative Scoliosis Research Society Society Questionnaire-30 (SRS-30) scores were correlated with the preoperative PCS score.
One hundred and eighty-nine patients underwent PSF for AIS, and 20 (10.6%) were considered to be experiencing pain catastrophizing. Despite comparable demographic and radiographic variables, pain catastrophizing was associated with significantly lower preoperative scores than were found in the normal-PCS group in all SRS-30 domains, including pain (2.98 versus 3.95; p < 0.001), appearance (2.98 versus 3.48; p < 0.001), activity (3.51 versus 4.06; p < 0.001), mental health (3.12 versus 4.01; p < 0.001), and total score (3.18 versus 3.84; p < 0.001), except satisfaction (3.72 versus 3.69; p > 0.999). At 2 years, the pain catastrophizing group experienced significant improvement from their preoperative scores in most SRS-30 domains, including a large clinically relevant improvement in pain (from 2.98 preoperatively to 3.84 postoperatively; p < 0.001) and the total score (from 3.18 to 3.85; p < 0.001), but continued to have lower scores than the normal-PCS group for pain (3.84 versus 4.22; p = 0.028) and the total score (3.85 versus 4.15; p = 0.038). Receiver operating characteristic (ROC) curve analysis indicated that an SRS-30 pain score of <3.5 has good sensitivity for predicting pain catastrophizing (PCS ≥75th percentile).
In this cohort, patients with AIS who exhibited pain catastrophizing experienced significant improvement in self-reported health 2 years after PSF. However, they did not have the same levels of self-reported health as the normal-PCS group. Pain catastrophizing may be identifiable by lower preoperative SRS-30 pain scores.
Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
患有青少年特发性脊柱侧凸（AIS）的患者常报告慢性背痛；然而，对于该患者人群中与疼痛相关的心理因素的研究还不够充分。疼痛灾难化是一种描述对疼痛的负面想法和感觉的模式的心理因素，与对疼痛的医疗治疗反应不佳有关。本研究的目的是报告 AIS 人群中疼痛灾难化的流行情况，并评估其与术前和术后自我报告结果的关系。
在这项对接受后路脊柱融合术（PSF）治疗 AIS 的连续患者进行的前瞻性队列研究中，将经历临床相关疼痛灾难化的患者（定义为疼痛灾难化量表儿童版（PCS）得分在第 75 百分位或更高）与 PCS 得分正常的患者进行比较。术前和术后 2 年 SRS 研究协会问卷-30（SRS-30）评分与术前 PCS 评分相关。
189 例患者接受了 AIS 的 PSF，其中 20 例（10.6%）被认为存在疼痛灾难化。尽管存在可比的人口统计学和影像学变量，但与 PCS 得分正常组相比，疼痛灾难化患者在所有 SRS-30 领域的术前评分均显著较低，包括疼痛（2.98 与 3.95；p<0.001）、外观（2.98 与 3.48；p<0.001）、活动（3.51 与 4.06；p<0.001）、心理健康（3.12 与 4.01；p<0.001）和总分（3.18 与 3.84；p<0.001），除满意度（3.72 与 3.69；p>0.999）外。在 2 年时，疼痛灾难化组在大多数 SRS-30 领域的术前评分均有显著改善，包括疼痛（从术前的 2.98 分改善至术后的 3.84 分；p<0.001）和总分（从 3.18 分改善至 3.85 分；p<0.001）均有较大的临床相关改善，但疼痛（3.84 与 4.22；p=0.028）和总分（3.85 与 4.15；p=0.038）的评分仍低于 PCS 得分正常组。受试者工作特征（ROC）曲线分析表明，SRS-30 疼痛评分<3.5 对预测疼痛灾难化（PCS≥75 百分位）具有良好的敏感性。
在本队列中，表现出疼痛灾难化的 AIS 患者在 PSF 后 2 年自我报告的健康状况有显著改善。然而，他们的自我报告健康水平与 PCS 得分正常组并不相同。疼痛灾难化可能通过较低的术前 SRS-30 疼痛评分来识别。
预后 II 级。有关证据水平的完整描述，请参见作者说明。
