Pain Self-Efficacy: A Modifiable Target to Improve Surgery Outcomes

Lacking beliefs held by people with chronic pain that they can carry out certain activities, even when experiencing pain can modulate the effect of prescribed opioid consumption in spine surgery, according to a study published in The Spine Journal. Previous studies showed that lower pain self-efficacy is associated with higher pain intensity and greater pain interference in day-to-day life. However, the Johns Hopkins research team believes its study is among the first to investigate pain self-efficacy’s correlation with daily preoperative prescribed opioid consumption (1^✔ ✔Trusted Source
Self-efficacy as a mediator of the relationship between pain and disability in chronic pain patients: a narrative review

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Patients having spine surgery report higher levels of pre-surgery prescribed opioid use than patients having any other surgical procedure. Additionally, past studies found that, among patients seeking elective spine surgery, sustained preoperative opioid use is a major predictor of persistent postoperative opioid use.

Role of Preoperative Self-Efficacy in Predicting Outcome After Spine Surgery

This is significant because post-surgery dependence on opioids can lead to worse health outcomes, such as persistent pain and increased risk of opioid misuse (2^✔ ✔Trusted Source
The role of preoperative self-efficacy in predicting outcome after total knee replacement

Go to source). Therefore, surgeons must identify candidates for spine surgery who have a high likelihood of using daily prescribed opioids before their surgery.

For the study, the team recruited 578 patients — all from a single Johns Hopkins tertiary-care hospital — who had elective spine surgery between August 2020 and December 2021. Nearly half of the participants were women, and the mean age was 55.

Before surgery, the participants completed the Pain Self-Efficacy Questionnaire (PSEQ). Higher scores indicate greater pain self-efficacy, with 60 being the highest possible score.

The research team found that spine surgery candidates with a PSEQ score of less than 22 were twice as likely to engage in daily preoperative prescribed opioid use — even when controlling for pain and disability (3^✔ ✔Trusted Source
Pain Self-Efficacy (PSEQ) score of <22 is associated with daily opioid use, back pain, disability, and PROMIS scores in patients presenting for spine surgery.

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Based on the findings, researchers believe orthopedic surgeons can use pain self-efficacy scores to identify patients who are likely to be using prescribed opioids daily before surgery. Surgeons can help these patients improve their pain self-efficacy scores through education and counseling before surgery.

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This can strengthen the patient’s ability to cope with pain, reduce their usage of opioid medications and consequently improve their postoperative quality of life. The research team plans to continue researching how pain self-efficacy relates to outcomes for patients having spine surgery, including other factors that can hinder postoperative recovery.

References:

1. Self-efficacy as a mediator of the relationship between pain and disability in chronic pain patients: a narrative review - (https://bfpt.springeropen.com/articles/10.1186/s43161-022-00101-y)
2. The role of preoperative self-efficacy in predicting outcome after total knee replacement - (https://pubmed.ncbi.nlm.nih.gov/22368121/)< /span>
3. Pain Self-Efficacy (PSEQ) score of <22 is associated with daily opioid use, back pain, disability, and PROMIS scores in patients presenting for spine surgery - (https://www.thespinejournalonline.com/article/S1529-9430(22)01077-4/fulltext)

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Source-Eurekalert