Influence of preoperative pain, cognitions, and quantitative sensory testing measures on the effects of perioperative pain neuroscience education for people receiving surgery for lumbar radiculopathy: secondary analysis of a randomized controlled trial

OBJECTIVE: To explore whether preoperative pain intensity, pain cognitions, and quantitative sensory measures influence the established effectiveness of perioperative pain neuroscience education (PPNE) on health-related quality of life at 1 year after surgery for lumbar radiculopathy. DESIGN: Secondary analysis of a triple-blinded randomized controlled trial. METHODS: Participants (n=90) were Dutch-speaking adults (18-65 years) who were scheduled for surgery for lumbar radiculopathy in 3 Belgian hospitals. They were randomized (1:1) to receive PPNE (n=41) or perioperative biomedical education (PBE; n=49). Linear mixed models were built for health-related quality of life (i.e., SF-6D utility values, Physical, and Mental Component of the Short-Form 36-item Survey) using the following independent variables: therapy, time, and preoperative scores for back, and leg pain intensity, pain catastrophizing, kinesiophobia, hypervigilance, and quantitative sensory measures. RESULTS: The impact of PPNE on SF-6D utility values over time was influenced by kinesiophobia (F=3.30; p=.02) and leg pain intensity (F=3.48; p=.02). Regardless of the intervention, back pain intensity negatively influenced SF-6D values over time (F=3.99; p=.009). The Physical Component scores were negatively impacted by back pain intensity (F=9.08; p=.003) and were influenced over time by leg pain intensity (F=2.87; p=.04). The Mental Component scores were negatively impacted by back pain intensity (F=6.64; p=.01), pain catastrophizing (F=5.42; p=.02), as well as hypervigilance (F=3.16; p=.03) and leg pain intensity (F=3.12; p=.03) over time. CONCLUSION: PPNE may be more effective than PBE in improving postoperative health utility values in patients who reported higher kinesiophobia and leg pain intensity before surgery for lumbar radiculopathy.