Self-perception of quality of life and identification of alexithymia in failed back surgery syndrome patients

Martins, Marielza Regina Ismael; Cunha, Ana Marcia Rodrigues da; Forni, Jose Eduardo Nogueira; Santos, Randolfo dos; Dias, Lilian Chessa; Araujo, Gerardo Maria de

doi:10.5935/1806-0013.20170006

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ORIGINAL ARTICLES • Rev. dor 18 (1) • Jan-Mar 2017 • https://doi.org/10.5935/1806-0013.20170006 copy

Self-perception of quality of life and identification of alexithymia in failed back surgery syndrome patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

Failed back surgery syndrome is one of the most frequent nosological entities in a Pain Clinic and is characterized by the persistent maintenance of lumbar and/or lower limbs pain complaints in individuals already submitted to lumbar vertebral surgery. This study aimed at evaluating quality of life and at investigating the presence of alexithymia in a sample of individuals with failed back surgery syndrome, in addition to analyzing correlations between pain intensity and symptoms of anxiety and depression.

METHODS:

This is a descriptive, exploratory, comparative, cross-sectional study with quantitative approach in a sample of individuals with failed back surgery syndrome (G1) (n=38) and a group with low back pain without surgical intervention (G2) (n=42) of a Teaching Hospital Pain Clinic. Participants were evaluated by the Brief Pain Inventory and the Toronto Alexithymia scale. Emotional factors, such as anxiety and depression, were evaluated by Beck scales and quality of life by the generic WHOQOL-BREF questionnaire.

RESULTS:

There were mean alexithymia, anxiety and depression scores significantly higher for G1 and poorer quality of life in all domains as compared to G2. There were significant correlations between alexithymia and depression (p<0.01) and quality of life (except for the environment domain) and anxiety/depression (p<0.001).

CONCLUSION:

Results have highlighted the negative impact of frequently under-diagnosed psychological variables on quality of life. A better understanding of these emotional reactions may promote a more effective participation of health professionals.

Keywords:
Alexithymia; Low back pain; Post-laminectomy syndrome; Quality of life; Reoperation

Variables	Groups	n	Mean±SD	%
Education level (years)	G1	38	7±4.5
	G2	42	8±3.8
Pain duration (months)	G1	38	8±6.8
	G2	42	9±8.7
Labor situation
Formal job				10.5(n=4)
Health insurance				47(n=18)
Retired				28 (n=11)
Informal job	G1	38		14.5 (n=5)
Formal job	G2	42		30.9(n=13)
Health insurance				11.9(n=5)
Retired				19.1(n=8)
Informal job				38.1(n=16)

Tools	GI (n=38)	GII (n=42)	p
	Mean ± SD	Mena ±SD	value
BPI
Pain intensity	9.04±2.3	8.50±3.2	0.054
Interference of pain with general activities
Mood	8.35±3.04	6.48±3.5	0.048^* * Significance level – p<0.05; G1 = diagnosis of failed back surgery; G2 = low back pain without surgical intervention. BPI – brief pain inventory; BDI = depression inventory; BAI = anxiety inventory; TAS = Toronto alexithymia scale. According to mean TAS scores, there has been prevalence of alexithymia (<74) taking into account cutoff scores established by Yoshida10.
Walking ability	7.32±2.50	4.50±1.7	0.036^* * Significance level – p<0.05; G1 = diagnosis of failed back surgery; G2 = low back pain without surgical intervention. BPI – brief pain inventory; BDI = depression inventory; BAI = anxiety inventory; TAS = Toronto alexithymia scale. According to mean TAS scores, there has been prevalence of alexithymia (<74) taking into account cutoff scores established by Yoshida10.
At sleep	9.35±1.98	5.80±2.8	0.045^* * Significance level – p<0.05; G1 = diagnosis of failed back surgery; G2 = low back pain without surgical intervention. BPI – brief pain inventory; BDI = depression inventory; BAI = anxiety inventory; TAS = Toronto alexithymia scale. According to mean TAS scores, there has been prevalence of alexithymia (<74) taking into account cutoff scores established by Yoshida10.
At work	8.50±2.35	5.60±2.5	0.048^* * Significance level – p<0.05; G1 = diagnosis of failed back surgery; G2 = low back pain without surgical intervention. BPI – brief pain inventory; BDI = depression inventory; BAI = anxiety inventory; TAS = Toronto alexithymia scale. According to mean TAS scores, there has been prevalence of alexithymia (<74) taking into account cutoff scores established by Yoshida10.
On personal relationships	5.65±3.25	4.75±1.5	0.065
On enjoying life	6.50±3.50	4.50±2.5	0.045^* * Significance level – p<0.05; G1 = diagnosis of failed back surgery; G2 = low back pain without surgical intervention. BPI – brief pain inventory; BDI = depression inventory; BAI = anxiety inventory; TAS = Toronto alexithymia scale. According to mean TAS scores, there has been prevalence of alexithymia (<74) taking into account cutoff scores established by Yoshida10.
BDI	24.9±12.6	18.6±5.4	0.045^* * Significance level – p<0.05; G1 = diagnosis of failed back surgery; G2 = low back pain without surgical intervention. BPI – brief pain inventory; BDI = depression inventory; BAI = anxiety inventory; TAS = Toronto alexithymia scale. According to mean TAS scores, there has been prevalence of alexithymia (<74) taking into account cutoff scores established by Yoshida10.
BAI	17.8±3.4	8.2±4.6	0.028^* * Significance level – p<0.05; G1 = diagnosis of failed back surgery; G2 = low back pain without surgical intervention. BPI – brief pain inventory; BDI = depression inventory; BAI = anxiety inventory; TAS = Toronto alexithymia scale. According to mean TAS scores, there has been prevalence of alexithymia (<74) taking into account cutoff scores established by Yoshida10.
TAS
F1 (identify feeling)	36.5±7.0	28.5±8.5	0.036^* * Significance level – p<0.05; G1 = diagnosis of failed back surgery; G2 = low back pain without surgical intervention. BPI – brief pain inventory; BDI = depression inventory; BAI = anxiety inventory; TAS = Toronto alexithymia scale. According to mean TAS scores, there has been prevalence of alexithymia (<74) taking into account cutoff scores established by Yoshida10.
F2 (fantasize)	10.9±4.0	5.4±3.8	0.045^* * Significance level – p<0.05; G1 = diagnosis of failed back surgery; G2 = low back pain without surgical intervention. BPI – brief pain inventory; BDI = depression inventory; BAI = anxiety inventory; TAS = Toronto alexithymia scale. According to mean TAS scores, there has been prevalence of alexithymia (<74) taking into account cutoff scores established by Yoshida10.
F3 (communicate feeling)	14.8±3.2	9.6±5.4	0.038^* * Significance level – p<0.05; G1 = diagnosis of failed back surgery; G2 = low back pain without surgical intervention. BPI – brief pain inventory; BDI = depression inventory; BAI = anxiety inventory; TAS = Toronto alexithymia scale. According to mean TAS scores, there has been prevalence of alexithymia (<74) taking into account cutoff scores established by Yoshida10.
F4 (focus on work)	13.2±2.8	10.8±2.5	0.034^* * Significance level – p<0.05; G1 = diagnosis of failed back surgery; G2 = low back pain without surgical intervention. BPI – brief pain inventory; BDI = depression inventory; BAI = anxiety inventory; TAS = Toronto alexithymia scale. According to mean TAS scores, there has been prevalence of alexithymia (<74) taking into account cutoff scores established by Yoshida10.
Total	75.4±6.3	60.5±1.2	0.035^* * Significance level – p<0.05; G1 = diagnosis of failed back surgery; G2 = low back pain without surgical intervention. BPI – brief pain inventory; BDI = depression inventory; BAI = anxiety inventory; TAS = Toronto alexithymia scale. According to mean TAS scores, there has been prevalence of alexithymia (<74) taking into account cutoff scores established by Yoshida10.

TAS	Mean±SD	Minimum	Maximum
F1	36.5±7.0	19	45
F2	10.9±4.0	6	17
F3	14.8±3.2	11	21
F4	13.2±2.8	9	20
Total	75.4±6.3	59	90

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[1] Correspondence to: Departamento de Ciências Neurológicas Avenida Brigadeiro Faria Lima, 5416 - Bairro São Pedro 15090-000 São Jose do Rio Preto, SP, Brasil. E-mail: marielzamartins@famerp.br