Influence of Pain Sensitivity on Surgical Outcomes of Arthroscopic Rotator Cuff Repair: A Prospective Cohort Study

Abstract

Background:

The Pain Sensitivity Questionnaire (PSQ) has been found to be a valid tool, and PSQ scores have been shown to be predictive of outcomes after surgery for lumbar stenosis. The effect of pain sensitivity on outcomes of rotator cuff repair (RCR) surgery has not been examined.

Hypothesis:

PSQ scores would be associated with surgical outcomes after arthroscopic RCR surgery.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Patients 18 to 80 years old scheduled for RCR were consecutively enrolled. Patients with glenohumeral arthritis grade ≥2 or RCR revision surgery were excluded. PSQ was completed preoperatively. The Disabilities of the Arm, Shoulder and Hand score and American Shoulder and Elbow Surgeons score were used as patient-reported outcome measurements (PROMs), and visual analog scale pain score was documented as well. Active shoulder external rotation (ER), internal rotation, and anterior forward elevation range of motion (ROM) were recorded. PROMs and ROM measurements were recorded preoperatively and at 3 months, 6 months, and 1 year after surgery. Rotator cuff tear size, type of repair, and concomitant procedures were documented. Patients were classified as having high or normal pain sensitivity based on PSQ scores.

Results:

Of 100 enrolled patients, 38 patients were classified as having high pain sensitivity. Patients with high pain sensitivity had worse American Shoulder and Elbow Surgeons and Disabilities of the Arm, Shoulder and Hand scores preoperatively, 6 months postoperatively, and 1 year postoperatively (P < .01). From the preoperative assessment to 3 months postoperatively, PROMs improved more in patients with high versus normal pain sensitivity. However, for patients with high pain sensitivity, PROMs plateaued after 3 months but continued to improve for patients with normal pain sensitivity (P < .01). Visual analog scale pain scores were higher at all time points for patients with high pain sensitivity (P < .05). Preoperatively, patients with high pain sensitivity had restricted active ROM compared with patients who had normal pain sensitivity for anterior forward elevation, ER, and internal rotation (P = .009, P = .012, and P = .006, respectively). By 1 year after surgery, ER ROM was still restricted in patients with high pain sensitivity.

Conclusion:

Pain sensitivity is an important factor influencing RCR outcomes. Patients with high pain sensitivity undergoing RCR showed less improvement in active ROM and worse PROMs after surgery compared with patients who had normal pain sensitivity. Preoperative PSQ may predict postoperative improvements.

Keywords

rotator cuff tear pain sensitivity surgical outcomes clinical assessment

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References

Angst

Schwyzer

Aeschlimann

Simmen

Goldhahn

. Measures of adult shoulder function: Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and its short version (QuickDASH), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Society standardized shoulder assessment form, Constant (Murley) Score (CS), Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), and Western Ontario Shoulder Instability Index (WOSI). Arthritis Care Res (Hoboken). 2011;63(suppl 11):S174-S188.

Cuff

O’Brien

Pupello

Santoni

. Evaluation of factors affecting acute postoperative pain levels after arthroscopic rotator cuff repair. Arthroscopy. 2016;32(7):1231-1236.

Desai

Cheung

. Postoperative pain associated with orthopedic shoulder and elbow surgery: a prospective study. J Shoulder Elbow Surg. 2012;21(4):441-450.

Gwilym

Oag

Tracey

Carr

. Evidence that central sensitization is present in patients with shoulder impingement syndrome and influences the outcome after surgery. J Bone Joint Surg Br. 2011;93(4):498-502.

Kiecolt Glaser

Page

Marucha

, et al. Psychological influences on surgical recovery: perspectives from psychoneuroimmunology. Am Psychol. 1998;53:1209-1218.

Kim

Kholinne

, et al. Minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state after arthroscopic rotator cuff repair. Am J Sports Med. 2020;48(11):2650-2659.

Kim

Lee

Kang

, et al. Influence of pain sensitivity on surgical outcomes after lumbar spine surgery in patients with lumbar spinal stenosis. Spine (Phila Pa 1976). 2015;40(3):193-200.

Mathews

Ridgeway

. Personality and surgical recovery: a review. Br J Clin Psychol. 1981;20:243-260.

Nicholas

. The pain self-efficacy questionnaire: taking pain into account. Eur J Pain. 2007;11:153-163.

10.

Nicholas

Lee

Mullaney

, et al. Functional outcomes after double-row versus single-row rotator cuff repair: a prospective randomized trial. Orthop J Sports Med. 2016;4(10):2325967116667398.

11.

Niekel

Lindenhovius

Watson

Vranceanu

Ring

. Correlation of DASH and QuickDASH with measures of psychological distress. J Hand Surg Am. 2009;34:1499-1505.

12.

Nota

Bot

Ring

Kloen

. Disability and depression after orthopaedic trauma. Injury. 2015;46:207-212.

13.

Kim

Bin

Gong

. Prognostic factors affecting anatomic outcome of rotator cuff repair and correlation with functional outcome. Arthroscopy. 2009;25(1):30-39.

14.

Ravindra

Barlow

Jones

Bishop

. A prospective evaluation of predictors of pain after arthroscopic rotator cuff repair: psychosocial factors have a stronger association than structural factors. J Shoulder Elbow Surg. 2018;27(10):1824-1829.

15.

Rizvi

SMT

Bishop

Lam

Murrell

GAC

. Factors predicting frequency and severity of postoperative pain after arthroscopic rotator cuff repair surgery. Am J Sports Med. 2021;49(1):146-153.

16.

Ruscheweyh

Marziniak

Stumpenhorst

Reinholz

Knecht

. Pain sensitivity can be assessed by self-rating: development and validation of the Pain Sensitivity Questionnaire. Pain. 2009;146(1-2):65-74.

17.

Tashjian

Bradley

Tocci

Rey

Henn

Green

. Factors influencing patient satisfaction after rotator cuff repair. J Shoulder Elbow Surg. 2007;16(6):752-758.

18.

Thorpe

O’Sullivan

Mitchell

, et al. Are psychologic factors associated with shoulder scores after rotator cuff surgery? Clin Orthop Relat Res. 2018;476(10):2062-2073.

19.

Vranceanu

Bachoura

Weening

Vrahas

Smith

Ring

. Psychological factors predict disability and pain intensity after skeletal trauma. J Bone Joint Surg Am. 2014;96:e20.

20.

Yaari

Dolev

Kittani

, et al. Preoperative pain sensitivity questionnaire helps customize pain management after arthroscopic partial meniscectomy. Knee Surg Sports Traumatol Arthrosc. 2021;29(12):4198-4204.