Relationship of anxiety-related symptoms with pain, disability and postoperative period after degenerative lumbar spinal stenosis surgery

Goktug Ulku; Muhammed Erkan Emrahoğlu; Elif Figen Emrahoğlu; Habibullah Dolgun; Erhan Türkoğlu

doi:10.31362/patd.1474502

EN TR

Relationship of anxiety-related symptoms with pain, disability and postoperative period after degenerative lumbar spinal stenosis surgery

Abstract

Purpose: This study investigates the anxiety symptom levels of patients who underwent surgery due to degenerative lumbar spinal stenosis (DLSS), and the relationship between anxiety symptoms and postoperative pain, disability, and time elapsed after surgery was investigated. Materials and methods: The research study group comprises 71 patients, and the control group comprises 65 healthy individuals. In the study, the pain, disability, and anxiety symptom levels of the patients were evaluated. Postoperative State Anxiety Inventory (SAI) and Trait Anxiety Inventory (TAI) scores of DLSS patients and healthy individuals were compared. The variability of the anxiety scores of the individuals in the study group was analyzed in separate groups divided according to gender, postoperative period, pain, and disability scores. Patients were divided into two groups: painful (VAS >6) and pain-free (VAS <7), according to Visual Analogue Scale (VAS) scores representing pain levels. Results: The results show that the patient's anxiety symptom levels are higher than the healthy controls and that anxiety scores increase even more in patients with high pain and disability scores. Higher pain and disability scores were associated with higher SAI scores. Moreover, it was found that both the painful early postoperative and painful late postoperative groups had higher SAI scores compared to the pain-free early postoperative and pain-free late postoperative groups. Conclusion: These findings emphasize the importance of considering pain, physical disabilities, and anxiety symptoms together in supporting the postoperative recovery process. It can be said that holistic approaches focusing on pain, physical disabilities and anxiety can positively affect recovery. More extensive and prospective studies are needed to elucidate the causal relationship between these concepts.

Keywords

Anxiety, disability, pain, spinal stenosis, surgery

Ethical Statement

This study was conducted according to the principles stated in the Declaration of Helsinki and approved by the human research ethics committee of Etlik City Hospital (Registration No:AEŞH-EK1-2023-439 / 09.08.2023).

Dejeneratif lomber spinal stenoz cerrahisi sonrası anksiyete ilişkili semptomlar ile ağrı, engellilik ve postoperatif süre arasındaki ilişki

Abstract

Amaç: Bu çalışmada dejeneratif lomber spinal stenoz (DLSS) nedeniyle ameliyat geçiren hastaların anksiyete ilişkili semptom düzeyleri ve bu durumun ameliyat sonrası ağrı, engellilik ve ameliyattan sonra geçen süre ile ilişkisi araştırılmıştır. Gereç ve yöntem: Araştırma çalışma grubu 71 hastadan, kontrol grubu ise 65 sağlıklı bireyden oluşmaktadır. Çalışmada hastaların ağrı, sakatlık ve anksiyete ilişkili semptom düzeyleri değerlendirilmiştir. DLSS hastalarının ve sağlıklı bireylerin Postoperatif Durumluk Anksiyete Envanteri (DAE) ve Süreklilik Anksiyete Envanteri (SAE) puanları karşılaştırılmıştır. Çalışma grubundaki bireylerin anksiyete puanlarının değişkenliği cinsiyete, ameliyat sonrası geçmiş olan süreye, ağrıya ve sakatlık puanlarına göre ayrı gruplar halinde analiz edilmiştir. Hastalar ağrı düzeylerini temsil eden Görsel Analog Skala (VAS) puanlarına göre ağrılı (VAS >6) ve ağrısız (VAS <7) olmak üzere iki gruba ayrılmıştır. Bulgular: Sonuçlar hastaların anksiyete semptom düzeylerinin sağlıklı kontrollerden daha yüksek olduğunu ve yüksek ağrı ve sakatlık puanına sahip hastalarda anksiyete puanlarının daha da arttığını göstermektedir. Daha yüksek ağrı ve sakatlık puanları daha yüksek DAE puanlarıyla ilişkilendirildi. Dahası hem ağrılı erken postoperatif hem de ağrılı geç postoperatif gruplarının ağrısız erken postoperatif ve ağrısız geç postoperatif gruplarına kıyasla daha yüksek DAE puanlarına sahip olduğu bulundu. Sonuç: Bu bulgular, postoperatif iyileşme sürecini desteklemede ağrı, fiziksel sakatlıklar ve anksiyete semptomlarının birlikte ele alınmasının önemini vurgulamaktadır. Ağrıya, fiziksel sakatlıklara ve anksiyeteye odaklanan bütünsel yaklaşımların iyileşmeyi olumlu yönde etkileyebileceği söylenebilir. Bu kavramlar arasındaki nedensel ilişkiyi açıklamak için daha kapsamlı ve prospektif çalışmalara ihtiyaç vardır.

Keywords

Anksiyete, engellilik, ağrı, spinal stenoz, ameliyat

References

Ravindra VM, Senglaub SS, Rattani A, et al. Degenerative Lumbar Spine Disease: Estimating Global Incidence and Worldwide Volume. Global Spine J. 2018;8(8):784-794. doi:10.1177/2192568218770769
Bydon M, Alvi MA, Goyal A. Degenerative Lumbar Spondylolisthesis: Definition, Natural History, Conservative Management, and Surgical Treatment. Neurosurg Clin N Am. 2019;30(3):299-304. doi:10.1016/j.nec.2019.02.003
Hughey AB, Lesniak MS, Ansari SA, Roth S. What will anesthesiologists be anesthetizing? Trends in neurosurgical procedure usage. Anesth Analg. 2010;110(6):1686-1697. doi:10.1213/ANE.0b013e3181cbd9cc
Katz JN, Zimmerman ZE, Mass H, Makhni MC. Diagnosis and Management of Lumbar Spinal Stenosis: A Review. Jama. 2022;327(17):1688-1699. doi:10.1001/jama.2022.5921
Martinez Urrutia A. Anxiety and pain in surgical patients. J Consult Clin Psychol. 1975;43(4):437-442. doi:10.1037/h0076898
Darnall BD. Pain Psychology and Pain Catastrophizing in the Perioperative Setting: A Review of Impacts, Interventions, and Unmet Needs. Hand Clin. 2016;32(1):33-39. doi:10.1016/j.hcl.2015.08.005
Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG. Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first? Spine (Phila Pa 1976). 1993;18(1):66-71. doi:10.1097/00007632-199301000-00011
Härter M, Reuter K, Weisser B, Schretzmann B, Aschenbrenner A, Bengel J. A descriptive study of psychiatric disorders and psychosocial burden in rehabilitation patients with musculoskeletal diseases. Arch Phys Med Rehabil. 2002;83(4):461-468. doi:10.1053/apmr.2002.30924
Rusinov V. Anxiety among Adults Undergoing Elective Lumbar Spine Surgery at University of California–San Diego Medical Center–La Jolla. 2022.
Held U, Burgstaller JM, Deforth M, Steurer J, Pichierri G, Wertli MM. Association between depression and anxiety on symptom and function after surgery for lumbar spinal stenosis. Sci Rep. 2022;12(1):2821. doi:10.1038/s41598-022-06797-1

Lebow R, Parker SL, Adogwa O, et al. Microdiscectomy improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc. Neurosurgery. 2012;70(2):306-311;discussion 311. doi:10.1227/NEU.0b013e3182302ec3.
Theunissen M, Peters ML, Bruce J, Gramke HF, Marcus MA. Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clin J Pain. 2012;28(9):819-841. doi:10.1097/AJP.0b013e31824549d6
Goyal DKC, Stull JD, Divi SN, et al. Combined Depression and Anxiety Influence Patient-Reported Outcomes after Lumbar Fusion. Int J Spine Surg. 2021;15(2):234-242. doi:10.14444/8008
Jackson KL, Rumley J, Griffith M, Agochukwu U, DeVine J. Correlating Psychological Comorbidities and Outcomes After Spine Surgery. Global Spine J. 2020;10(7):929-939. doi:10.1177/2192568219886595
Zieger M, Schwarz R, König HH, Härter M, Riedel-Heller SG. Depression and anxiety in patients undergoing herniated disc surgery: relevant but underresearched - a systematic review. Cent Eur Neurosurg. 2010;71(1):26-34. doi:10.1055/s-0029-1225325
Robleda G, Sillero-Sillero A, Puig T, Gich I, Baños JE. Influence of preoperative emotional state on postoperative pain following orthopedic and trauma surgery. Rev Lat Am Enfermagem. 2014;22(5):785-791. doi:10.1590/0104-1169.0118.2481
Netto MB, Barranco ABS, Oliveira KWK, Petronilho F. Influence of anxiety and depression symptoms on the quality of life in patients undergoing lumbar spine surgery. Rev Bras Ortop. 2018;53(1):38-44. doi:10.1016/j.rboe.2017.01.009
Dunn LK, Durieux ME, Fernández LG, et al. Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery. J Neurosurg Spine. 2018;28(1):119-126. doi:10.3171/2017.5.Spine1734
Aalto TJ, Malmivaara A, Kovacs F, et al. Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: systematic review. Spine (Phila Pa 1976). 2006;31(18):E648-E663. doi:10.1097/01.brs.0000231727.88477.da
Bekeris J, Wilson LA, Fiasconaro M, et al. New Onset Depression and Anxiety After Spinal Fusion Surgery: Incidence and Risk Factors. Spine (Phila Pa 1976). 2020;45(16):1161-1169. doi:10.1097/brs.0000000000003467
Spielberger CD, Gonzalez-Reigosa F, Martinez-Urrutia A, Natalicio LFS, Natalicio DS. The state-trait anxiety inventory. Interamerican Journal of Psychology. 1971;5:145-158.
Beneciuk JM, Robinson ME, George SZ. Subgrouping for patients with low back pain: a multidimensional approach incorporating cluster analysis and the STarT Back Screening Tool. J Pain. 2015;16(1):19-30. doi:10.1016/j.jpain.2014.10.004
Oei TP, Evans L, Crook GM. Utility and validity of the STAI with anxiety disorder patients. Br J Clin Psychol. 1990;29(4):429-32. doi:10.1111/j.2044-8260.1990.tb00906.x
Huskisson EC. Measurement of pain. Lancet. 1974;2(7889):1127-1131. doi:10.1016/s0140-6736(74)90884-8
Fairbank J. Revised Oswestry Disability questionnaire. Spine (Phila Pa 1976). 2000;25(19):2552. doi:10.1097/00007632-200010010-00025
Yakut E, Düger T, Oksüz C, et al. Validation of the Turkish version of the Oswestry Disability Index for patients with low back pain. Spine (Phila Pa 1976). 2004;29(5):581-5;discussion 585. doi:10.1097/01.brs.0000113869.13209.03
Boonstra AM, Schiphorst Preuper HR, Balk GA, Stewart RE. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain. PAIN®. 2014;155(12):2545-2550. doi:https://doi.org/10.1016/j.pain.2014.09.014
Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain. 1997;72(1-2):95-97. doi:10.1016/s0304-3959(97)00005-5
Shafshak TS, Elnemr R. The Visual Analogue Scale Versus Numerical Rating Scale in Measuring Pain Severity and Predicting Disability in Low Back Pain. J Clin Rheumatol. 2021;27(7):282-285. doi:10.1097/rhu.0000000000001320
Rahman R, Ibaseta A, Reidler JS, et al. Changes in patients' depression and anxiety associated with changes in patient-reported outcomes after spine surgery. J Neurosurg Spine. 2020:1-20. doi:10.3171/2019.11.Spine19586
Surman OS. The surgical patient, Massachusetts General Hospital Handbook of General Hospital Psychiatry. TP Hackett, NH Cassem (Ed), 2. Baskı, Littleton. PSG Publishing; 1987.
Falavigna A, Righesso O, Teles AR, et al. Responsiveness of depression and its influence on surgical outcomes of lumbar degenerative diseases. Eur J Orthop Surg Traumatol. 2015;25 Suppl 1:S35-41. doi:10.1007/s00590-015-1651-0
Angelini E, Wijk H, Brisby H, Baranto A. Patients' Experiences of Pain Have an Impact on Their Pain Management Attitudes and Strategies. Pain Manag Nurs. 2018;19(5):464-473. doi:10.1016/j.pmn.2018.02.067
Guillén Riquelme A, Buela Casal G. Meta-analysis of group comparison and meta-analysis of reliability generalization of the State-Trait Anxiety Inventory Questionnaire (STAI). Rev Esp Salud Publica. 2014;88(1):101-12. doi:10.4321/s1135-57272014000100007
Forrest SJ, Siegert RJ, Krägeloh CU, Landon J, Medvedev ON. Generalizability theory distinguishes between state and trait anxiety. Psychol Assess. 2021;33(11):1080-1088. doi:10.1037/pas0001060
Leal PC, Goes TC, da Silva LCF, Teixeira-Silva F. Trait vs. state anxiety in different threatening situations. Trends Psychiatry Psychother. 2017;39(3):147-157. doi:10.1590/2237-6089-2016-0044
Glowacki D. Effective pain management and improvements in patients' outcomes and satisfaction. Crit Care Nurse. 2015;35(3):33-41;quiz 43. doi:10.4037/ccn2015440
Wilson BR, Tringale KR, Hirshman BR, et al. Depression After Spinal Surgery: A Comparative Analysis of the California Outcomes Database. Mayo Clin Proc. 2017;92(1):88-97. doi:10.1016/j.mayocp.2016.06.030
Otani K, Kikuchi S, Yabuki S, et al. Lumbar spinal stenosis has a negative impact on quality of life compared with other comorbidities: an epidemiological cross-sectional study of 1862 community-dwelling individuals. ScientificWorldJournal. 2013;2013:590652. doi:10.1155/2013/590652
Jackson T, Tian P, Wang Y, Iezzi T, Xie W. Toward Identifying Moderators of Associations Between Presurgery Emotional Distress and Postoperative Pain Outcomes: A Meta-Analysis of Longitudinal Studies. J Pain. 2016;17(8):874-88. doi:10.1016/j.jpain.2016.04.003
Coronado RA, George SZ, Devin CJ, Wegener ST, Archer KR. Pain Sensitivity and Pain Catastrophizing Are Associated With Persistent Pain and Disability After Lumbar Spine Surgery. Arch Phys Med Rehabil. 2015;96(10):1763-1770. doi:10.1016/j.apmr.2015.06.003
Costelloe C, Burns S, Yong RJ, Kaye AD, Urman RD. An Analysis of Predictors of Persistent Postoperative Pain in Spine Surgery. Curr Pain Headache Rep. 2020;24(4):11. doi:10.1007/s11916-020-0842-5
Fernandez M, Colodro-Conde L, Hartvigsen J, et al. Chronic low back pain and the risk of depression or anxiety symptoms: insights from a longitudinal twin study. Spine J. 2017;17(7):905-912. doi:10.1016/j.spinee.2017.02.009
Cimilli C. Anxiety in Surgery. Turkish Journal of Clinical Psychiatry. 2001;4(3):182-186.
Jiménez Almonte JH, Hautala GS, Abbenhaus EJ, et al. Spine patients demystified: what are the predictive factors of poor surgical outcome in patients after elective cervical and lumbar spine surgery? Spine J. 2020;20(10):1529-1534. doi:10.1016/j.spinee.2020.05.550
İnci A, Şenol N. Evaluation of patients with degenerative lumbar spinal stenosis after surgery in terms of anxiety and depression. Medical Journal of Süleyman Demirel University. 2014;21(1):7-10.
Ozer AF, Oktenoglu T, Egemen E, et al. Lumbar Single-Level Dynamic Stabilization with Semi-Rigid and Full Dynamic Systems: A Retrospective Clinical and Radiological Analysis of 71 Patients. Clin Orthop Surg. Sep 2017;9(3):310-316. doi:10.4055/cios.2017.9.3.310
Canbulat N, Oktenoglu T, Ataker Y, et al. A Rehabilitation Protocol for Patients with Lumbar Degenerative Disc Disease Treated with Posterior Transpedicular Dynamic Stabilization. Turk Neurosurg. 2017;27(3):426-435. doi:10.5137/1019-5149.Jtn.16326-15.1

Details

Primary Language

English

Subjects

Surgery (Other)

Journal Section

Research Article

Authors

Goktug Ulku ^*
0000-0003-1430-2977
Türkiye

Muhammed Erkan Emrahoğlu
0000-0002-0939-3117
Türkiye

Elif Figen Emrahoğlu
0000-0002-1870-3906
Türkiye

Habibullah Dolgun
0000-0002-1513-2044
Türkiye

Erhan Türkoğlu
0000-0001-7044-617X
Türkiye

Early Pub Date

December 5, 2024

Publication Date

January 1, 2025

Submission Date

April 27, 2024

Acceptance Date

October 26, 2024

Published in Issue

Year 2025 Volume: 18 Number: 1

DOI

https://doi.org/10.31362/patd.1474502

IZ

https://izlik.org/JA29ZU56TT

APA

Ulku, G., Emrahoğlu, M. E., Emrahoğlu, E. F., Dolgun, H., & Türkoğlu, E. (2025). Relationship of anxiety-related symptoms with pain, disability and postoperative period after degenerative lumbar spinal stenosis surgery. Pamukkale Medical Journal, 18(1), 73-85. https://doi.org/10.31362/patd.1474502

AMA

1.Ulku G, Emrahoğlu ME, Emrahoğlu EF, Dolgun H, Türkoğlu E. Relationship of anxiety-related symptoms with pain, disability and postoperative period after degenerative lumbar spinal stenosis surgery. Pam Med J. 2025;18(1):73-85. doi:10.31362/patd.1474502

Chicago

Ulku, Goktug, Muhammed Erkan Emrahoğlu, Elif Figen Emrahoğlu, Habibullah Dolgun, and Erhan Türkoğlu. 2025. “Relationship of Anxiety-Related Symptoms With Pain, Disability and Postoperative Period After Degenerative Lumbar Spinal Stenosis Surgery”. Pamukkale Medical Journal 18 (1): 73-85. https://doi.org/10.31362/patd.1474502.

EndNote

Ulku G, Emrahoğlu ME, Emrahoğlu EF, Dolgun H, Türkoğlu E (January 1, 2025) Relationship of anxiety-related symptoms with pain, disability and postoperative period after degenerative lumbar spinal stenosis surgery. Pamukkale Medical Journal 18 1 73–85.

IEEE

[1]G. Ulku, M. E. Emrahoğlu, E. F. Emrahoğlu, H. Dolgun, and E. Türkoğlu, “Relationship of anxiety-related symptoms with pain, disability and postoperative period after degenerative lumbar spinal stenosis surgery”, Pam Med J, vol. 18, no. 1, pp. 73–85, Jan. 2025, doi: 10.31362/patd.1474502.

ISNAD

Ulku, Goktug - Emrahoğlu, Muhammed Erkan - Emrahoğlu, Elif Figen - Dolgun, Habibullah - Türkoğlu, Erhan. “Relationship of Anxiety-Related Symptoms With Pain, Disability and Postoperative Period After Degenerative Lumbar Spinal Stenosis Surgery”. Pamukkale Medical Journal 18/1 (January 1, 2025): 73-85. https://doi.org/10.31362/patd.1474502.

JAMA

1.Ulku G, Emrahoğlu ME, Emrahoğlu EF, Dolgun H, Türkoğlu E. Relationship of anxiety-related symptoms with pain, disability and postoperative period after degenerative lumbar spinal stenosis surgery. Pam Med J. 2025;18:73–85.

MLA

Ulku, Goktug, et al. “Relationship of Anxiety-Related Symptoms With Pain, Disability and Postoperative Period After Degenerative Lumbar Spinal Stenosis Surgery”. Pamukkale Medical Journal, vol. 18, no. 1, Jan. 2025, pp. 73-85, doi:10.31362/patd.1474502.

Vancouver

1.Goktug Ulku, Muhammed Erkan Emrahoğlu, Elif Figen Emrahoğlu, Habibullah Dolgun, Erhan Türkoğlu. Relationship of anxiety-related symptoms with pain, disability and postoperative period after degenerative lumbar spinal stenosis surgery. Pam Med J. 2025 Jan. 1;18(1):73-85. doi:10.31362/patd.1474502

Pamukkale Medical Journal is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY NC).

Relationship of anxiety-related symptoms with pain, disability and postoperative period after degenerative lumbar spinal stenosis surgery

Abstract

Keywords

Ethical Statement

Dejeneratif lomber spinal stenoz cerrahisi sonrası anksiyete ilişkili semptomlar ile ağrı, engellilik ve postoperatif süre arasındaki ilişki

Abstract

Keywords

References

Details

Primary Language

Subjects

Journal Section

Authors

Early Pub Date

Publication Date

Submission Date

Acceptance Date

Published in Issue

DOI

IZ

Cite