Effects of 360-degree lumbar fusion in a workers' compensation population.

STUDY DESIGN: Eighty-one patients who were receiving workers' compensation and who met structured inclusion criteria for low back pain and disability underwent 360 degrees lumbar fusion with decompression and were compared to 16 similar patients who did not receive the surgery because of administrative reasons outside the authors' control. Patients completed standardized questionnaires to assess their level of functioning before surgery and every 6 months after surgery for 24 months or more. OBJECTIVES: To determine the efficacy of 360 degrees lumbar fusion within a sample of patients receiving workers' compensation using sound methods of outcome evaluation. SUMMARY OF BACKGROUND DATA: The results of previous studies have shown that lumbar fusion may not be effective with patients receiving workers' compensation. Unsound methods preclude firm conclusions, however, and the data on pathophysiology of lumbar spine injuries suggests a multiplicity of pain generators in these patients. The 360 degrees lumbar fusion with generous decompression surgery described in this report addresses these pain generator mechanisms. METHOD: Patients completed valid and reliable questionnaires independent of the surgeon's input before surgery and every 6 months after surgery. Data were examined in groups (surgery and nonsurgery) multiplied by assessment time (before surgery, 0-6 months, 6-18 months, 18-24 months, and 24+ months) analysis of variance. RESULTS: Ninety-one percent of patients who underwent surgery reported a positive response. Compared with the nonsurgery group, these patients reported reduced pain intensity, increased activity level, decreased disability, and improved confidence in performing routine activities. Differences were maintained at all follow-up examinations, although only one-third of the patients who underwent surgery were available at the final follow-up examination. No differences were observed on measures of emotional health. CONCLUSIONS: Circumferential (360 degrees) lumbar fusion can be a highly effective method of reducing pain and disability in patients receiving workers' compensation.

On the utility of the West Haven-Yale Multidimensional Pain Inventory.

STUDY DESIGN: Two studies evaluated the West Haven-Yale Multidimensional Pain Inventory. This 52-item inventory contains 12 scales divided into 3 parts: 1) interference, support, pain severity, self-control, and negative mood; 2) punishing responses, solicitous responses, and distracting responses; and 3) household chores, outdoor work, activities away from home, and social activities. OBJECTIVES: The objective of study 1 was to investigate the internal structure of the Multidimensional Pain Inventory and its demographic correlates. The objective of study 2 was to explore its external correlates (construct validity). SUMMARY OF BACKGROUND DATA: The Multidimensional Pain Inventory appears promising because of its brevity, scope, ease of administration, and initial results. Despite this, it has attracted very little attention in the orthopedic literature since its introduction nearly a decade ago. METHOD: The internal structure was examined using oblique multiple group confirmatory factor analysis. Demographic correlates were examined using discriminant analysis. The external correlates were examined using multiple regression and discriminant analysis. RESULTS: The items' proposed structure fit well except that two pairs of scales are poorly separated: 1) activities away from home and social activities, and 2) solicitous responses and distracting responses. Correlations with external criteria are meaningful. CONCLUSIONS: The Multidimensional Pain Inventory meets standards of reliability and convergent validity, and it may be an improvement over current psychometric devices used to this same end.

Effects of pain duration on psychosocial adjustment in orthopedic patients: the importance of early diagnosis and treatment of pain.

Six hundred thirty-five orthopedic patients who were consecutively referred to an outpatient pain assessment service were grouped into one of five pain-duration categories: 0-3 mo, 4-6 mo, 7-9 mo, 9-12 mo, and more than 12 mo. Comprehensive psychosocial assessment of the patients revealed that longer pain-duration patients are older, complain of greater body surface in pain, have had more surgery, have been out of work longer, report taking more pain medication, have been married more times, are more likely to be involved in worker's compensation, and report a greater likelihood of current suicidal ideation. In addition, patients with longer pain duration showed higher pain intensity and sensitivity, less confidence in coping ability, higher dependency traits, and greater reliability of self-report. Finally, longer pain duration was associated with reports of more symptoms of psychopathologic disturbance, especially in patients with pain durations from 9 to 12 mo. Because the data presented are correlation in nature, prospective analysis of the psychosocial adjustment of orthopedic pain patients is suggested.

On the utility of the SCL-90-R with low-back pain patients.

The SCL-90-R has become an increasingly popular measure of maladjustment. Its use beyond simply screening chronic low-back pain (CLBP) patients has been criticized, however, in part, because it appears to be a single-factor instrument. In fact, its nine major scales do share only one important common factor, i.e., general psychological discomfort. The scale most applicable to CLBP, however, somatization (SOM), has sufficient specific variance that it does not simply measure discomfort and predicts several other measures better than the SCL-90-Rs more reliable composite measure (GSI). Using SOM in conjunction with the GSI to separate psychological from physical discomfort is therefore both clinically and psychometrically appropriate. Other objections to the test are critically evaluated. The potential clinical relevance of the SCL-90-R is discussed.