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WHAT DO PATIENTS CONSIDER TO BE AN ACCEPTABLE LEVEL OF PAIN TO LIVE WITH AFTER SURGERY FOR LUMBAR DEGENERATIVE DISORDERS?: O45

Fekete, T F; Kleinstueck, F S; Porchet, F; Haschtmann, D; Jeszenszky, D; Mannion, A F

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Spine Journal Meeting Abstracts: 2015 - Volume 2015 - Issue - p 20
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INTRODUCTION: The “minimal clinically important change score” is often used as a marker of treatment success but its achievement is dependent on the patient's starting point, and it does not indicate whether a satisfactory state is ultimately reached. An alternative approach concerns reporting the % of patients whose symptoms have reduced to a level that they could live with. We evaluated the acceptable level of pain in patients operated on for painful degenerative lumbar disorders. METHODS: Data from consecutive patients in our Spine Outcomes Registry undergoing first‐time surgery for disc herniation (DH; N=772), spinal stenosis (SS; N=558) and degenerative spondylolisthesis (DS; N=316) were analysed. 12 mo postoperatively, patients completed 0‐10 scales for back and leg pain and a question “if you had to spend the rest of your life with the symptoms you have now, how would you feel about it?”, with a 5‐point response scale from “very satisfied” to “very dissatisfied”. This was dichotomised and used as the external criterion in receiver operating characteristics (ROC) analysis to derive the cut‐off score for pain indicating being at least “somewhat satisfied”. RESULTS: 90% patients returned a 12‐mo questionnaire of which 55.6% (DH), 43.4% (SS) and 53.2% (DS) reported being at least somewhat satisfied with their symptom state. The areas under the curve for the ROC were 0.88‐0.91, indicating a good ability of the pain score to discriminate between being in a satisfactory state or not. The cut‐off indicating a satisfactory symptom state was ≤22 points for DH (sensitivity 78%, specificity 89%), ≤23 points for SS (sens 83%, spec 80%) and ≤23 points DS (sens 85%, spec 80%). CONCLUSION: Most spine interventions decrease pain but rarely do they totally eliminate it. Reporting of the % patients achieving a pain score equivalent to the “acceptable symptom state” may represent a more stringent target for denoting surgical success in the treatment of painful spinal disorders.

© 2015 Lippincott Williams & Wilkins, Inc.