North American Spine Society journal · 2025
Opioid-use disorder and reported pain after spine surgery: Risk-group patterns in cognitive-appraisal processes in a longitudinal cohort study.
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Schwartz CE, Borowiec K, Rapkin BD, Finkelstein JA, Sutherland T, Caan OB, Skolasky RL
Аннотация
BACKGROUND: As spinal disorders cause significant pain over an extended period, prolonged opioid use could lead to an increased risk of opioid-use disorder (OUD) over recovery. This study examined cognitive-appraisal processes as potential moderators of OUD-risk, after adjusting for demographic and clinical factors.
METHODS: This longitudinal cohort study included 342 adults undergoing surgical treatment for a back/leg problem, neck/arm/shoulder problem, or spinal deformity at a United States academic medical center. The Numeric Rating Scale assessed pain, and the Quality of Life Appraisal Profilev2-Short Form assessed cognitive-appraisal processes. Three self-report items on reported opioid use before and after surgery enabled dividing the sample into OUD risk groups, and patient medical records captured mention of presurgical opioid use and dependency concerns to validate our OUD risk classification. Regression models examined reported pain at 3 months, with independent variables of appraisal at presurgery, 3-months postsurgery, and change in appraisal; and OUD-risk group-by-appraisal interactions, after covariate adjustment. The Benjamini-Hochberg procedure reduced the false-discovery rate.
RESULTS: The OUD risk classification was validated. Baseline (presurgery) cognitive-appraisal processes moderated reported pain at 3-months postsurgery as a function of OUD risk in some areas. Notably, reported pain was lower among high-OUD risk patients who endorsed at presurgery more problem-resolution goals. In contrast, reported pain at 3 months was higher among low-OUD risk patients who endorsed at presurgery more problem-resolution goals. However, cognitive-appraisal processes at 3 months or change in appraisal did not moderate the relationship between OUD-risk group and pain.
CONCLUSIONS: Cognitive-appraisal processes at presurgery moderated the OUD-risk groups' experience of pain at 3 months postsurgery. For high OUD-risk patients, more goals were associated with less pain, whereas the opposite was true for low-risk patients. The group differences for presurgery appraisal may be useful targets of early cognitive and mindfulness interventions.
METHODS: This longitudinal cohort study included 342 adults undergoing surgical treatment for a back/leg problem, neck/arm/shoulder problem, or spinal deformity at a United States academic medical center. The Numeric Rating Scale assessed pain, and the Quality of Life Appraisal Profilev2-Short Form assessed cognitive-appraisal processes. Three self-report items on reported opioid use before and after surgery enabled dividing the sample into OUD risk groups, and patient medical records captured mention of presurgical opioid use and dependency concerns to validate our OUD risk classification. Regression models examined reported pain at 3 months, with independent variables of appraisal at presurgery, 3-months postsurgery, and change in appraisal; and OUD-risk group-by-appraisal interactions, after covariate adjustment. The Benjamini-Hochberg procedure reduced the false-discovery rate.
RESULTS: The OUD risk classification was validated. Baseline (presurgery) cognitive-appraisal processes moderated reported pain at 3-months postsurgery as a function of OUD risk in some areas. Notably, reported pain was lower among high-OUD risk patients who endorsed at presurgery more problem-resolution goals. In contrast, reported pain at 3 months was higher among low-OUD risk patients who endorsed at presurgery more problem-resolution goals. However, cognitive-appraisal processes at 3 months or change in appraisal did not moderate the relationship between OUD-risk group and pain.
CONCLUSIONS: Cognitive-appraisal processes at presurgery moderated the OUD-risk groups' experience of pain at 3 months postsurgery. For high OUD-risk patients, more goals were associated with less pain, whereas the opposite was true for low-risk patients. The group differences for presurgery appraisal may be useful targets of early cognitive and mindfulness interventions.