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Altered central pain processing in patients with degenerative lumbar diseases and its association with low physical activity levels after lumbar spinal surgeries: a retrospective cohort analysis

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Abstract

Purpose

To investigate the occurrence of altered central pain modulation in patients with degenerative lumbar diseases (DLDs) and to analyze its association with physical activity (PA) 3 years after lumbar decompression and fusion.

Methods

Preoperative assessments of pressure pain thresholds (PPTs), temporal summation (TS), conditioned pain modulation (CPM) and pain were, respectively, recorded in 304 patients. These patients further underwent International Physical Activity Questionnaire (IPAQ) and both pain-related and psychological assessments 3 years post-operation.

Results

Preoperatively, the patients had lower PPTs in both local pain and pain-free areas and lower CPM and higher TS in pain-free areas than healthy subjects (P < 0.05). Postoperatively, 53.9% (164/304) patients showed PA below healthy-related thresholds (< 600 MET min/w). Low PA group showed a greater postoperative weight gain and bone loss and a higher postoperative prevalence of both moderate anxiety and marginal depression than high PA group (P < 0.05). All covariates with differences between the high and low PA groups were subjected to multivariate logistic regression, and long preoperative disease duration, low preoperative PPT in pain-free area, high preoperative TS, revision surgery, severe postoperative low back pain and significant postoperative pain catastrophizing thought were independently associated with low postoperative PA (P < 0.05).

Conclusions

This study supports the existence of central sensitization (CS) caused by abnormal central pain modulation in DLDs. Pre-existing CS in these patients may be associated with low PA after lumbar surgeries, and this low-activity lifestyle may predispose patients to multiple adverse health outcomes. Preoperative dynamic quantitative sensory testing may provide information for the identification of at-risk patients.

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Data and materials availability

The datasets have been presented in the main manuscript, and the raw data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

Financial support from the Shanghai "Science and Technology Innovation Action Plan" Project (22s31900600) is gratefully acknowledged.

Author information

Author notes

  1. Kaiwen Chen and Cong Nie are contributed equally to this work and should be considered first authors.

  2. Jianyuan Jiang and Chaojun Zheng are contributed equally to this work and should be considered last authors.

Authors and Affiliations

  1. Department of Orthopedics, Huashan Hospital, Fudan University, 12 Mid-Wulumuqi Road, Shanghai, 200040, China

    Kaiwen Chen, Cong Nie, Feizhou Lyu, Jianyuan Jiang & Chaojun Zheng

  2. Department of Physical Medicine and Rehabilitation, Upstate Medical University, State University of New York at Syracuse, Syracuse, NY, 10212, USA

    Yu Zhu

  3. Department of Orthopedics, The Fifth People’s Hospital, Fudan University, Shanghai, 200240, China

    Feizhou Lyu

Authors
  1. Kaiwen Chen
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  2. Cong Nie
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  3. Yu Zhu
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  4. Feizhou Lyu
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Contributions

ZC and JJY have made substantial contributions to conception and design; CKW and NC have made substantial contributions to acquisition of data, or analysis and interpretation of data; ZY and LFZ have been involved in drafting the manuscript or revising it critically for important intellectual content; and all authors have given final approval of the version to be published.

Corresponding author

Correspondence to Chaojun Zheng.

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Conflict of interest

None of the authors have potential conflicts of interest to be disclosed. The authors alone are responsible for the content and writing of this paper.

Ethical approval

This study protocol was approved by the Ethics Committee of Huashan Hospital (Fudan University, Shanghai, China) (Approval number: KY2022-569).

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Chen, K., Nie, C., Zhu, Y. et al. Altered central pain processing in patients with degenerative lumbar diseases and its association with low physical activity levels after lumbar spinal surgeries: a retrospective cohort analysis. Eur Spine J 33, 543–552 (2024). https://doi.org/10.1007/s00586-023-08112-6

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  • DOI: https://doi.org/10.1007/s00586-023-08112-6

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