Multivariable mixed-model linear regression analyses illustrated the unique relation between postoperative positive affect and functional status and postoperative negative affect and pain interference and disability after spine surgery.
Consistent evidence supports a significant association between lower positive affect and higher negative affect and increased pain and disability in adults with chronic pain. However, examining this relation in surgical populations has received little empirical consideration. The primary purpose of this study was to determine whether preoperative and postoperative positive and negative affect predict pain, disability, and functional status after spine surgery. A secondary objective was to assess the relation of depression to postoperative outcomes compared with positive and negative affect. Participants were 141 patients treated by spine surgery for lumbar or cervical degeneration. Data collection occurred at baseline and 6 weeks and 3 months postoperatively. Affect was measured with the Positive and Negative Affect Schedule. Multivariable mixed-model linear regression analyses found that preoperative variables were not predictive of postoperative pain, disability and functional status. However, multivariable postoperative analysis found that 6-week positive affect predicted functional status, and 6-week negative affect predicted pain interference and pain-related disability at 3 months following surgery. Postoperative depression demonstrated statistically significant and stronger associations with pain intensity, pain interference, and pain-related disability at 3-month follow-up, as compared with negative affect. Results suggest that positive affect and depression are important variables to target when seeking to improve postoperative outcomes in a spine surgery population. Recommendations include postoperative screening for positive affect and depression, and treating depression as well as focusing on rehabilitation strategies to bolster positive affect so as to improve functional outcomes after spine surgery.
aDepartment of Psychology, Washington DC Veterans Affairs Medical Center, Washington, DC, USA
bDepartment of Psychology, Loyola University Maryland, Baltimore, Maryland, USA
cDepartment of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, Maryland, USA
dDepartment of Biostatistics, Vanderbilt University, School of Medicine, Nashville, Tennessee, USA
eDepartment of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
fDepartment of Orthopaedic Surgery and Rehabilitation, Vanderbilt University, School of Medicine, Nashville, Tennessee, USA
*Corresponding author. Address: Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University, School of Medicine, Medical Center East—South Tower, Suite 4200, Nashville, TN 37232, USA. Tel.: +1 615 322 2732; fax: +1 615 936 1566.
Submitted February 3, 2011; revised September 21, 2011; accepted October 6, 2011.