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Ability to Cope with Pain Puts Migraine Surgery Patients in Perspective

Gfrerer, Lisa, M.D., Ph.D.; Lans, Jonathan, M.D.; Faulkner, Heather, R., M.D., M.P.H.; Nota, Sjoerd, M.D., Ph.D.; Bot, Arjan G., J., M.D., Ph.D.; Austen, William, Gerald, Jr., M.D.

Plastic and Reconstructive Surgery: January 2018 - Volume 141 - Issue 1 - p 169–174
doi: 10.1097/PRS.0000000000003955
Reconstructive: Head and Neck: Original Article
Press Release

Background: Candidates for migraine surgery are chronic pain patients with significant disability. Currently, migraine-specific questionnaires are used to evaluate these patients. Analysis tools widely used in evaluation of better understood pain conditions are not typically applied. This is the first study to include a commonly used pain questionnaire, the Pain Self-Efficacy Questionnaire (PSEQ) that is used to determine patients’ pain coping abilities and function. It is an important predictor of pain intensity/disability in patients with musculoskeletal pain, as low scores have been associated with poor outcome.

Methods: Ninety patients were enrolled prospectively and completed the Migraine Headache Index and PSEQ preoperatively and at 12 months postoperatively. Scores were evaluated using paired t tests and Pearson correlation. Representative PSEQ scores for other pain conditions were chosen for score comparison.

Results: All scores improved significantly from baseline (p < 0.01). Mean preoperative pain coping score (PSEQ) was 18.2 ± 11.7, which is extremely poor compared with scores reported for other pain conditions. Improvement of PSEQ score after migraine surgery was higher than seen in other pain conditions after treatment (112 percent). Preoperative PSEQ scores did not influence postoperative outcome.

Conclusions: The PSEQ successfully demonstrates the extent of debility in migraine surgery patients by putting migraine pain in perspective with other known pain conditions. It further evaluates functional status, rather than improvement in migraine characteristics, which significantly adds to our understanding of outcome. Poor preoperative PSEQ scores do not influence outcome and should not be used to determine eligibility for migraine surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Boston, Mass.; and Amsterdam, The Netherlands

From the Division of Plastic and Reconstructive Surgery, the Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School; and the Orthopaedic Research Center Amsterdam, Academic Medical Center.

Received for publication April 28, 2017; accepted July 13, 2017.

Presented at the 96th Annual Meeting of the American Association of Plastic Surgeons, in Austin, Texas, March 25 through 28, 2017; and the 62nd Annual Meeting of the Plastic Surgery Research Council, in Durham, North Carolina, May 4 through 7, 2017.

Disclosure: The authors have no conflicts of interest to disclose. None of the authors has a financial interest in any of the products or devices mentioned in this article.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (www.PRSJournal.com).

William Gerald Austen, Jr., M.D., Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 15 Parkman Street, WACC 435, Boston, Mass. 02114, wausten@partners.org

©2018American Society of Plastic Surgeons