Role of adverse psychological conditions in pain-related disability of adult spinal deformity.

Abstract

Background context: Current research on mental health in adult spinal deformity (ASD) patients remains relatively scarce, particularly regarding specific psychological factors including anxiety, kinesiophobia and pain catastrophizing. These negative psychological factors have been associated with worse pain and function in studies of patients with common lumbar diseases (CLD). It is currently unknown whether these psychological factors play a similar role in ASD patients. A comprehensive understanding of adverse psychological conditions within the ASD population and their associations with physical disability could enable the implementation of targeted preoperative psychological interventions, potentially improving postoperative outcomes through enhanced psychological preparedness.

Purpose: This study aimed to (1) compare the severity of anxiety, kinesiophobia, and pain catastrophizing, between ASD and CLD patients; (2) evaluate their associations with pain, disability, and quality of life (QoL); and (3) identify the psychological variables which independently associated with baseline pain-related disability in ASD patients, after controlling for clinical and demographic variables.

Methods: This cross-sectional study utilized data from a longitudinally maintained database on 121 ASD and 126 CLD patients who had posterior spinal fusion surgery between March 2023 and June 2024. Patients completed the State-Trait Anxiety Inventory (STAI), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and 12-item Short-Form Health Survey version 2 (SF-12v2). Group comparisons, correlation analyses, and hierarchical multivariable linear regression were performed.

Results: ASD patients reported more prevalent and severe pain catastrophizing (25.8 ± 11.9 vs. 18.7 ± 12.7, p < 0.001; 36.4% vs. 23.8%, p = 0.022) and anxiety (STAI-Total: 91.9 ± 18.0 vs. 84.6 ± 20.3, p = 0.003; 71.9% vs. 59.5%, p = 0.045) than CLD. Trait-anxiety was the strongest correlated psychological factor with mental health in ASD (r = -0.545, p < 0.001). Pain catastrophizing and kinesiophobia correlated significantly with VAS, ODI, and SF-12, especially for pain catastrophizing (r = 0.664 for ODI, p < 0.001). After controlling for confounding variables including age and pain intensity, higher pain catastrophizing was independently associated with worse physical disability (β = 0.693, p < 0.001). A hierarchical multivariable regression analysis found that 14.9% of variance in baseline ODI was explained by pain catastrophizing.

Conclusion: Compared to the CLD patients, patients with ASD suffer from worse mental health. A range of different psychological factors, including anxiety, kinesiophobia, and pain catastrophizing, were found to be associated with pain intensity, disability and QoL in ASD. Pain catastrophizing could explain a significant portion of variance of disability in ASD.