Kumar Shray, Koschmeder Katelyn T, Coffman Alex R, Glass Natalie A, Keffala Valerie J, Igram Cassim M, Pugely Andrew J, Olinger Catherine R
University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States.
N Am Spine Soc J. 2024 May 30;19:100330. doi: 10.1016/j.xnsj.2024.100330. eCollection 2024 Sep.
Chronic pain is an issue that affects over 100 million Americans daily. Acceptance and Commitment Therapy (ACT) has been found to be beneficial for patients with chronic pain by focusing provider efforts on teaching coping mechanisms for pain instead of eliminating the pain entirely. Current studies demonstrate that ACT significantly improves post-operative chronic pain scores and outcomes.
The 200 patients chosen via random generator were collected and presented to (institution) orthopedic spine surgeons along with additional information such as the patients' history of present illness, Visual Analog Scale (VAS) scores, PROMIS-CAT Pain Interference scores, and status of opiate usage. Surgeons were blinded to the PCS cutoff scores. The (institution) orthopedic spine surgeons then identified which patients they would indicate for ACT and their reasoning. Pre-determined PCS score cut-offs were separately used to determine if a patient was indicated for ACT.
The effectiveness of this screening tool was based on the frequency at which the surgeons and PCS scores were complimentary. A department epidemiologist assisted in the analysis of the data with the use of a ROC curve. ROC Curve demonstrated an area under the curve of 0.7784 with a Sensitivity of 0.68 and a Specificity of 0.79. The cut point according to Youden's index is 35. The data showed that the PCS is moderately accurate in its ability to distinguish coinciding patients that the [institution] orthopedic spine surgeons referred for ACT. The adjusted cut-point indicates that patients above a PCS of 35 would be referred to ACT by the orthopedic spine surgeons while those below a PCS score of 35 would not be referred.
Using the PCS, a referral with the department pain psychologist would occur by [institution] orthopedic spinal surgeons for patients that are deemed at-risk with a score of at least 35. The goal following this study is to perform future investigations regarding PCS and ACT with patients regarding chronic opioid use and postoperative outcomes. Patients who would be referred for help with chronic pain would be compared to PCS-referred patients and non-referred patients. Pre-operative ACT would be compared to patient outcomes post-operatively. The future aim is to use the cut-offs established in this study for experimental design to evaluate if PCS-referred patients have better pain management post-operatively as compared to the control and previously referred patients.
Level III diagnostic study.
慢性疼痛是一个每天影响着超过1亿美国人的问题。接纳与承诺疗法（ACT）已被发现对慢性疼痛患者有益，因为它将医疗人员的工作重点放在教授疼痛应对机制上，而非完全消除疼痛。目前的研究表明，ACT能显著改善术后慢性疼痛评分及预后。
通过随机生成器选取200名患者，并将其连同患者现病史、视觉模拟评分（VAS）、患者报告结果测量信息系统 - 疼痛干扰量表（PROMIS - CAT）评分以及阿片类药物使用状况等额外信息，一并提交给（机构名称）的骨科脊柱外科医生。外科医生对患者报告结果测量信息系统（PCS）的截断分数不知情。（机构名称）的骨科脊柱外科医生随后确定他们会为哪些患者推荐ACT及其理由。预先确定的PCS分数截断值分别用于确定患者是否适合接受ACT。
该筛查工具的有效性基于外科医生的判断与PCS分数相符的频率。一位部门流行病学家借助ROC曲线协助进行数据分析。ROC曲线显示曲线下面积为0.7784，灵敏度为0.68，特异度为0.79。根据约登指数确定的切点为35。数据表明，PCS在区分[机构名称]骨科脊柱外科医生推荐接受ACT的相符患者方面，准确性中等。调整后的切点表明，PCS分数高于35的患者将被骨科脊柱外科医生推荐接受ACT，而PCS分数低于35的患者则不会被推荐。
使用PCS，（机构名称）的骨科脊柱外科医生会为PCS得分至少为35、被视为有风险的患者转介至科室疼痛心理学家处。本研究之后的目标是针对慢性阿片类药物使用和术后结果，对患者进行关于PCS和ACT的未来调查。将被转介以寻求慢性疼痛帮助的患者与因PCS被转介的患者及未被转介的患者进行比较。术前ACT将与患者术后结果进行比较。未来的目标是使用本研究中确定的截断值进行实验设计，以评估与对照组及先前被转介的患者相比，因PCS被转介的患者术后疼痛管理是否更好。
三级诊断性研究。
