Psychological Distress Associated with Patient-Reported Outcomes in Preoperative Patients with Lumbar Spinal Stenosis

Study Design: Cross-sectional study. Purpose: The purpose of this study was to investigate the effects of psychotic symptoms such as anxiety and fear in patients undergoing lumbar spinal canal stenosis. Overview of Literature: Recently, patients with spinal disorders have not only been evaluated objectively for their disease, but also for patient-reported outcomes (PROs) including pain, physical function, and quality of life (PROs). Since depression has been previously associated with surgical outcomes, several studies have indicated that psychological problems may worsen the effects of pain and make treatment increasingly difficult. Methods: A questionnaire survey was conducted on 346 lumbar spinal stenosis (LSS) patients who visited our hospital from 2010 to 2016. The content of the questionnaire included questions on PROs (Japanese Orthopedic Association Back Pain Evaluation Questionnaire [JOABPEQ], Roland-Morris Disability Questionnaire, Japanese version [RDQ], and Zurich Claudication Questionnaire [ZCQ]) and psychological evaluation (Self-rating Questionnaire of Depression, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20 [PASS-20], Hospital Anxiety and Depression Scale, and Brief Scale for Psychiatric Problems in Orthopedic Patients). IBM SPSS Statistics (IBM Corp., Armonk, NY, USA) was used for statistical analysis and Spearman's rank correlation coefficient, Mann-Whitney U-test, and multiple regression analysis were also performed. Results: No significant correlations were found between psychological factors and PROs (r>0.4). However, patients with abnormal scores for preoperative psychological items on questionnaires other than the PASS-20 also had lower scores for lumbar spine dysfunction and social life dysfunction on the JOABPEQ subscales along with higher scores for the RDQ, symptom severity and physical function on the ZCQ compared to those with normal psychological scores (p<0.05). Conclusions: Preoperative psychological factors in patients with LSS were associated with their RDQ, JOABEPQ, and ZCQ scores. These results suggest that factors such as catastrophic thoughts on pain, anxiety, depression, and fear that may affect the clinical outcomes in patients with LSS should be evaluated before surgery to facilitate psychological interventions.