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Pain, disability and coping reflected in the diurnal cortisol variability in patients scheduled for lumbar disc surgery
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0002-4192-8273
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0001-5359-0452
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2008 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 5, p. 633-640Article in journal (Refereed) Published
Abstract [en]

Background: Symptoms of lumbar disc herniation can be induced by both mechanical compression of the nerve roots and by biochemical irritants from the disc tissues. Proinflammatory cytokines, as well as stress are potent stimulators of the hypothalamic–pituitary–adrenal axis, reflected in enhanced release of cortisol from the adrenal cortex. Altered cortisol production is also associated to behaviour and coping patterns.The aim of the present study was to explore the relation between pain, physical function, psychosocial factors and quality of life to the diurnal cortisol variability, in patients with lumbar disc herniation.

Method: This study had a cross-sectional design. Forty-two patients with lumbar disc herniation, verified by magnetic resonance imaging and a clinical examination by an orthopaedic surgeon, were included in the study. All patients were scheduled for disc surgery. The diurnal cortisol variability was examined before surgery. The patients were dichotomised into two groups based on low or high diurnal cortisol variability. Pain, disability, work related stress, quality of life, coping and fear avoidance beliefs, were estimated by standardised questionnaires.

Results: The low diurnal cortisol variability group was distinguished by a higher median score regarding leg pain at activity and significantly more disability (p < 0.05). The patients with a low diurnal cortisol variability had significantly lower coping self-statement scores, but higher pain coping catastrophising scores (p < 0.05).

Conclusion: Patients with lumbar disc herniation and a low diurnal cortisol variability had lower physical function, perceived lower possibilities of influencing their pain, and were more prone to catastrophise than patients with lumbar disc herniation and a high diurnal cortisol variability. 

Place, publisher, year, edition, pages
Amsterdam: Elsevier , 2008. Vol. 12, no 5, p. 633-640
Keywords [en]
Activities of Daily Living, Adaptation, Psychological, Adult, Circadian Rhythm, Cross-Sectional Studies, Employment, Fear, Female, Humans, Hydrocortisone/analysis/*secretion, Intervertebral Disk Displacement/pathology/*physiopathology/psychology/surgery, Lumbar Vertebrae/pathology, Magnetic Resonance Imaging, Male, Middle Aged, Neuralgia/etiology/*physiopathology, Pain Measurement, Preoperative Care, Quality of Life, Questionnaires, Saliva/chemistry, Sciatica, Sick Leave/statistics & numerical data, Stress/etiology/*physiopathology
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-3424DOI: 10.1016/j.ejpain.2007.10.009PubMedID: 18077197OAI: oai:DiVA.org:oru-3424DiVA, id: diva2:137721
Available from: 2008-12-04 Created: 2008-12-04 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Psychosocial factors in patients with lumbar disc herniation: enhancing postoperative outcome by the identifiction of predictive factors and optimised physiotherapy
Open this publication in new window or tab >>Psychosocial factors in patients with lumbar disc herniation: enhancing postoperative outcome by the identifiction of predictive factors and optimised physiotherapy
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Psychosocial factors have been advanced as an explanation for the development of chronic disability in 20 to 30% of patients treated by lumbar disc surgery.

Aims: The overall aim of this thesis was to study the role of psychosocial factors in patients undergoing first-time lumbar disc surgery in relation to the outcome of both surgery and subsequent physiotherapy.

Methods: Sixty-nine patients with lumbar disc herniation undergoing first-time disc surgery participated in the studies; in addition, Study I included 162 knee patients for comparison. Psychosocial factors were assessed preoperatively, as was the activation of the physiological stress response system. Pain, disabil-ity and quality of life were assessed before, and 3 and 12 months after surgery. Coping and kinesiophobia were analysed before and one year after surgery. The results of two different postoperative training programmes were compared.

Results: There were no differences between disc and knee patients regarding the presence of psychosocial stress factors preoperatively (Study I). Disc patients with low diurnal cortisol variability had lower physical function, perceived fewer possibilities to influence their pain and were more prone to catastrophise than patients with high diurnal cortisol variability (Study II). The results of clinic-based physiotherapy and home training did not differ regarding postoperative disability and pain 3 months after surgery. The home-based group had less pain and higher quality of life in comparison to the clinic-based group 12 months after surgery (Study III). Patients’ expectations of returning to work could best predict pain, disability, quality of life and sick leave one year after surgery (Study IV). Psychosocial factors were only weakly asso-ciated to pain, disability, quality of life and sick leave preoperatively. However, these associations were stronger in patients with residual pain one year after surgery.

Conclusion: Psychosocial factors and, in particular, patients’ expectations regarding outcome are associated with the results of lumbar disc surgery. Assessing psychosocial factors preoperatively and developing an active home training programme after surgery could create options leading to better results for these patients.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2008. p. 85
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 22
Keywords
Lumbar disc herniation, surgery, psychosocial factors, physio-therapy, expectations
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-2516 (URN)978-91-7668-633-1 (ISBN)
Public defence
2008-11-21, Aulan, ingång 21, Centrallasarettet, Västerås, 13:15 (English)
Opponent
Supervisors
Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2017-10-18Bibliographically approved

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Publisher's full textPubMedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=18077197&dopt=Citation

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Johansson, Ann-ChristinGunnarsson, Lars-GunnarLinton, Steven J.

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