TY - JOUR
T1 - The Mediating Role of Pain Cognitions and Pain Sensitivity in the Treatment Effect of Perioperative Pain Neuroscience Education in People Undergoing Surgery for Lumbar Radiculopathy
AU - Van Bogaert, Wouter
AU - Huysmans, Eva
AU - Coppieters, Iris
AU - Nijs, Jo
AU - Putman, Koen
AU - Ickmans, Kelly
AU - Moens, Maarten
AU - Goudman, Lisa
AU - Stas, Lara
AU - Buyl, Ronald
N1 - Funding Information:
This work was supported by the Agency for Innovation by Science and Technology (IWT) \u2013 Applied Biomedical Research Program (TBM), Belgium (Grant nr. 150180). WVB, EH, IC, and LG are funded by the Research Foundation Flanders (FWO), Belgium. JN is holder of a chair at the Vrije Universiteit Brussel, funded by the Berekuyl Academy, Hardewijk, The Netherlands. JN and the Vrije Universiteit Brussel received lecturing/ teaching fees from various professional associations and educational organizations outside of the submitted work. EH, LG, and JN have co-authored a Dutch book for clinicians on pain neuroscience education, but the royalties for that book are collected by the Vrije Universiteit Brussel and not them personally. MM received speaker fees from Medtronic, Nevro and Saluda outside of the submitted work. STIMULUS received independent research grants from Medtronic. There is no other conflict of interest to declare. The funding had no influence in the study concept, study design, data collection, nor any other research-related aspect that led to the preparation of this manuscript.
Publisher Copyright:
© 2024 United States Association for the Study of Pain, Inc.
PY - 2024/8
Y1 - 2024/8
N2 - Though perioperative pain neuroscience education (PPNE) positively influences patients’ surgical outcomes, little is known about the mechanisms behind this treatment's success. Therefore, this study aims to evaluate the potential mediating role of pain cognitions and pain sensitivity in the treatment effect of PPNE on postoperative quality of life in people undergoing surgery for lumbar radiculopathy. This secondary analysis uses data from 120 participants of a randomized controlled trial who were randomized to receive either PPNE or perioperative biomedical education before undergoing surgery for lumbar radiculopathy. Quality of life was assessed 1-year postsurgery using the short form 36-item health survey (SF36) physical and mental component scores. Potential mediators included pain cognitions (ie, kinesiophobia, pain catastrophizing, and hypervigilance) and pain sensitivity (ie, endogenous nociceptive modulation), assessed 6 weeks postsurgery. Mediation models were constructed using structural equation modeling, and 95% confidence intervals (CIs) were calculated using 10,000 bootstrap samples. Analyses show a significant total effect for PPNE (estimate = .464, 95% CI [.105, .825]) and a significant indirect effect via pain catastrophizing on the SF36 physical component (estimate = .124, 95% CI [.001, .293]). No mediating effect was found through the remaining pain cognitions or pain sensitivity measures. Also, no potential mediators were identified for the treatment effect of PPNE on the SF36 mental component. Our findings suggest that pain catastrophizing mediates the treatment effect of PPNE on physical health-related quality of life in people undergoing surgery for lumbar radiculopathy. Perspective: This secondary analysis identified pain catastrophizing as a mediator for PPNE in people undergoing surgery for lumbar radiculopathy. More so, its findings indicate that this educational intervention can enhance the postoperative physical health-related quality of life of these patients by addressing their catastrophizing thoughts. Trial registration: Clinicaltrials.gov (NCT02630732).
AB - Though perioperative pain neuroscience education (PPNE) positively influences patients’ surgical outcomes, little is known about the mechanisms behind this treatment's success. Therefore, this study aims to evaluate the potential mediating role of pain cognitions and pain sensitivity in the treatment effect of PPNE on postoperative quality of life in people undergoing surgery for lumbar radiculopathy. This secondary analysis uses data from 120 participants of a randomized controlled trial who were randomized to receive either PPNE or perioperative biomedical education before undergoing surgery for lumbar radiculopathy. Quality of life was assessed 1-year postsurgery using the short form 36-item health survey (SF36) physical and mental component scores. Potential mediators included pain cognitions (ie, kinesiophobia, pain catastrophizing, and hypervigilance) and pain sensitivity (ie, endogenous nociceptive modulation), assessed 6 weeks postsurgery. Mediation models were constructed using structural equation modeling, and 95% confidence intervals (CIs) were calculated using 10,000 bootstrap samples. Analyses show a significant total effect for PPNE (estimate = .464, 95% CI [.105, .825]) and a significant indirect effect via pain catastrophizing on the SF36 physical component (estimate = .124, 95% CI [.001, .293]). No mediating effect was found through the remaining pain cognitions or pain sensitivity measures. Also, no potential mediators were identified for the treatment effect of PPNE on the SF36 mental component. Our findings suggest that pain catastrophizing mediates the treatment effect of PPNE on physical health-related quality of life in people undergoing surgery for lumbar radiculopathy. Perspective: This secondary analysis identified pain catastrophizing as a mediator for PPNE in people undergoing surgery for lumbar radiculopathy. More so, its findings indicate that this educational intervention can enhance the postoperative physical health-related quality of life of these patients by addressing their catastrophizing thoughts. Trial registration: Clinicaltrials.gov (NCT02630732).
UR - http://www.scopus.com/inward/record.url?scp=85190950382&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jpain.2024.03.017
DO - https://doi.org/10.1016/j.jpain.2024.03.017
M3 - Article
VL - 25
JO - The Journal of Pain
JF - The Journal of Pain
SN - 1526-5900
IS - 8
M1 - 104521
ER -