Assessment of anxiety and pain in patients with lumbosacral radiculopathy at the early stage of rehabilitation with various rehabilitation programs after microdiscectomy

Cover Page


Cite item

Full Text

Abstract

Rationale: The role of the psychogenic component in chronic pain and delayed rehabilitation in patients with lumbosacral radiculopathy (LSR) has been extensively studied. However, there is a paucity of studies evaluating anxiety and pain in LSR patients early after microdiscectomy. Only a few studies have performed a differentiated assessment of state (SA) and trait (TA) anxiety. The effects of repetitive peripheral magnetic stimulation (rPMS) on the TA level in the Russian LSR patients have not been investigated. Aim: To assess changes in anxiety and pain over time in LSR patients with various rehabilitation programs at the early stage after microdiscectomy. Materials and methods: The study included 71 patients with LSR after microdiscectomy (mean age 46.8 ± 10.5 years). At Day 7 after surgery, the patients were randomized into two groups. The patients in the 1st group (n = 35) received a rPMS course in addition to conventional rehabilitation, whereas the patients in the 2nd group (n = 36) were rehabilitated only conventionally. Pain was assessed by a visual analogue scale (VAS), and anxiety levels by Spielberger StateTrait Anxiety Inventory (validated Russian version). Results: There was a significant decrease of SA and TA levels in the patients of both groups at Day 21 of rehabilitation, compared to those at Day 7 (p < 0.001). At Day 21, there was a significant inter-group difference (p = 0.036) in the leg pain VAS score and the TA frequency distribution (p = 0.042, Fisher test). Conclusion: Better improvement of pain and trait anxiety in the patients treated with rPMS indicates that it would be reasonable to include an rPMS course into the comprehensive rehabilitation program after microdiscectomy.

About the authors

V. N. Blokhina

National Medical and Surgical Center named after N.I. Pirogov

Author for correspondence.
Email: vnba1@mail.ru
ORCID iD: 0000-0002-7819-5229

Vera N. Blokhina – MD, Neurologist, Department of Neurology, Consultative and Diagnostic Center “Arbatsky”

37/1 Gagarinskiy per., Moscow, 119002
Tel.: +7 (499) 464 03 03

70 Nizhnyaya Pervomayskaya ul., Moscow, 105203

Russian Federation

E. G. Melikyan

Hillingdon Hospital

Email: fake@neicon.ru
ORCID iD: 0000-0002-5760-2454

Elina G. Melikyan – Consultant Neurologist

Pield Heath Road, Uxbridge, London, UB8 3NN

 

United Kingdom

References

  1. Albayrak S, Ozturk S, Durdag E, Ayden Ö. Surgical management of recurrent disc herniations with microdiscectomy and long-term results on life quality: Detailed analysis of 70 cases. J Neurosci Rural Pract. 2016;7(1): 87–90. doi: 10.4103/0976-3147.165426.
  2. Seiger A, Gadjradj PS, Harhangi BS, van Susante JL, Peul WC, van Tulder MW, de Boer MR, Rubinstein SM. PTED study: design of a non-inferiority, randomised controlled trial to compare the effectiveness and cost-effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) versus open microdiscectomy for patients with a symptomatic lumbar disc herniation. BMJ Open. 2017;7(12):e018230. doi: 10.1136/bmjopen-2017-018230.
  3. Parker SL, Mendenhall SK, Godil SS, Sivasubramanian P, Cahill K, Ziewacz J, McGirt MJ. Incidence of low back pain after lumbar discectomy for herniated disc and its effect on patient-reported outcomes. Clin Orthop Relat Res. 2015;473(6):1988–99. doi: 10.1007/s11999-015-4193-1.
  4. Кривошапкин АЛ, Семин ПА, Некрасов АД. Причины и профилактика неудачной хирургии после микродискэктомии. Бюллетень СО РАМН. 2013;33(3):20–3.
  5. Amirdelfan K, Webster L, Poree L, Sukul V, McRoberts P. Treatment Options for Failed Back Surgery Syndrome Patients With Refractory Chronic Pain: An Evidence Based Approach. Spine (Phila Pa 1976). 2017;42 Suppl 14:S41–52. doi: 10.1097/BRS.0000000000002217.
  6. Крупаткин АИ, Кулешов АА, Соколова ТВ, Господ АО. Патопсихологические аспекты болевых синдромов в нижней части спины. Журнал неврологии и психиатрии им. С.С. Корсакова. 2017;117(4):102–6. doi: 10.17116/jnevro201711741102-106.
  7. Blond S, Mertens P, David R, Roulaud M, Rigoard P. From "mechanical" to "neuropathic" back pain concept in FBSS patients. A systematic review based on factors leading to the chronification of pain (part C). Neurochirurgie. 2015;61 Suppl 1:S45–56. doi: 10.1016/j.neuchi.2014.11.001.
  8. Булюбаш ИД. Синдром неудачно оперированного позвоночника: психологические аспекты неудовлетворительных исходов хирургического лечения. Хирургия позвоночника. 2012;(3):49–56. doi: 10.14531/ss2012.3.49-56.
  9. Dorow M, Löbner M, Stein J, Konnopka A, Meisel HJ, Günther L, Meixensberger J, Stengler K, König HH, Riedel-Heller SG. Risk Factors for Postoperative Pain Intensity in Patients Undergoing Lumbar Disc Surgery: A Systematic Review. PLoS One. 2017;12(1):e0170303. doi: 10.1371/journal.pone.0170303.
  10. Даминов ВД. Дифференцированное применение стимуляционных методов в комплексном восстановительном лечении больных дорсопатией после дискэктомий: дис. … канд. мед. наук. М.; 2006. 150 с.
  11. Крючкова СВ. Эффективность баклосана в комплексной терапии мышечно-тонических болевых синдромов в раннем послеоперационном периоде после микродискэктомии. Журнал неврологии и психиатрии им. С.С. Корсакова. 2015;115(3):41–4. doi: 10.17116/jnevro20151153141-44.
  12. Lebow R, Parker SL, Adogwa O, Reig A, Cheng J, Bydon A, McGirt MJ. Microdiscectomy improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc. Neurosurgery. 2012;70(2):306–11. doi: 10.1227/NEU.0b013e3182302ec3.
  13. Laufenberg-Feldmann R, Kappis B, Cámara RJA, Ferner M. Anxiety and its predictive value for pain and regular analgesic intake after lumbar disc surgery – a prospective observational longitudinal study. BMC Psychiatry. 2018;18(1):82. doi: 10.1186/s12888-018-1652-8.
  14. D'Angelo C, Mirijello A, Ferrulli A, Leggio L, Berardi A, Icolaro N, Miceli A, D'Angelo V, Gasbarrini G, Addolorato G. Role of trait anxiety in persistent radicular pain after surgery for lumbar disc herniation: a 1-year longitudinal study. Neurosurgery. 2010;67(2):265–71. doi: 10.1227/01.NEU.0000371971.51755.1C.
  15. Kerr D, Zhao W, Lurie JD. What are long-term predictors of outcomes for lumbar disc herniation? A randomized and observational study. Clin Orthop Relat Res. 2015;473(6): 1920–30. doi: 10.1007/s11999-014-3803-7.
  16. Rossini PM, Burke D, Chen R, Cohen LG, Daskalakis Z, Di Iorio R, Di Lazzaro V, Ferreri F, Fitzgerald PB, George MS, Hallett M, Lefaucheur JP, Langguth B, Matsumoto H, Miniussi C, Nitsche MA, Pascual-Leone A, Paulus W, Rossi S, Rothwell JC, Siebner HR, Ugawa Y, Walsh V, Ziemann U. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol. 2015;126(6):1071–107. doi: 10.1016/j.clinph.2015.02.001.
  17. Struppler A, Angerer B, Gündisch C, Havel P. Modulatory effect of repetitive peripheral magnetic stimulation on skeletal muscle tone in healthy subjects: stabilization of the elbow joint. Exp Brain Res. 2004;157(1):59–66. doi: 10.1007/s00221003-1817-6.
  18. Куликов АГ, Воронина ДД, Луппова ИВ, Абрамович СГ. Новый подход к реабилитации пациентов после оперативного лечения грыж межпозвонковых дисков. Медико-социальная экспертиза и реабилитация. 2016;19(3):125–8. doi: 10.18821/1560-9537-2016-19-3-125-128.
  19. Babbs CF. A compact theory of magnetic nerve stimulation: predicting how to aim. Biomed Eng Online. 2014;13:53. doi: 10.1186/1475-925X-13-53.
  20. Smania N, Corato E, Fiaschi A, Pietropoli P, Aglioti SM, Tinazzi M. Repetitive magnetic stimulation: a novel therapeutic approach for myofascial pain syndrome. J Neurol. 2005;252(3):307–14. doi: 10.1007/s00415005-0642-1.
  21. Lim YH, Song JM, Choi EH, Lee JW. Effects of Repetitive Peripheral Magnetic Stimulation on Patients With Acute Low Back Pain: A Pilot Study. Ann Rehabil Med. 2018;42(2):229–38. doi: 10.5535/arm.2018.42.2.229.
  22. Massé-Alarie H, Flamand VH, Moffet H, Schneider C. Peripheral neurostimulation and specific motor training of deep abdominal muscles improve posturomotor control in chronic low back pain. Clin J Pain. 2013;29(9):814–23. doi: 10.1097/AJP.0b013e318276a058.
  23. Massé-Alarie H, Beaulieu LD, Preuss R, Schneider C. Repetitive peripheral magnetic neurostimulation of multifidus muscles combined with motor training influences spine motor control and chronic low back pain. Clin Neurophysiol. 2017;128(3):442–53. doi: 10.1016/j.clinph.2016.12.020.
  24. Kumru H, Albu S, Vidal J, Tormos JM. Effectiveness of repetitive trancranial or peripheral magnetic stimulation in neuropathic pain. Disabil Rehabil. 2017;39(9):856–66. doi: 10.3109/09638288.2016.1170213.
  25. Гореликов АЕ, Мельникова ЕА, Разумов АН, Рассулова МА, Рудь ИМ. Реабилитация больных с синдромом оперированного позвоночника с осложненным течением послеоперационного периода после дискэктомии. Вопросы курортологии, физиотерапии и лечебной физической культуры. 2017;94(5):40–7. doi: 10.17116/kurort201794540-47.
  26. Бородулина ИВ, Рачин АП, Бадалов НГ, Гуща АО. Периферическая ритмическая магнитная стимуляция при нейрогенных расстройствах мочеиспускания: обзор литературы и результаты клинического исследования. Нервно-мышечные болезни. 2017;7(2):54–66. doi: 10.17650/2222-8721-2017-7-2-54-66.
  27. Николаев СГ. Электромиография: клинический практикум. Иваново: ПресСто; 2013. 394 с.
  28. Гребень НФ. Психологические тесты для профессионалов. Минск: Современная школа; 2007. 496 с.
  29. Mancuso CA, Duculan R, Cammisa FP, Sama AA, Hughes AP, Lebl DR, Girardi FP. Successful lumbar surgery results in improved psychological well-being: a longitudinal assessment of depressive and anxiety symptoms. Spine J. 2018;18(4):606–13. doi: 10.1016/j.spinee.2017.08.260.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2020 Blokhina V.N., Melikyan E.G.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies