Chronic pain after spine surgery: Insights into pathogenesis, new treatment, and preventive therapy

Qichao Wu; Xiang Cui; Leo C Guan; Chi Zhang; Jing Liu; Neil C Ford; Shaoqiu He; Xueming Chen; Xu Cao; Lei Zang; Yun Guan

doi:10.1016/j.jot.2023.07.003

Chronic pain after spine surgery: Insights into pathogenesis, new treatment, and preventive therapy

J Orthop Translat. 2023 Sep 30:42:147-159. doi: 10.1016/j.jot.2023.07.003. eCollection 2023 Sep.

Authors

Qichao Wu^{1

2}, Xiang Cui¹, Leo C Guan³, Chi Zhang¹, Jing Liu¹, Neil C Ford¹, Shaoqiu He¹, Xueming Chen⁴, Xu Cao⁵, Lei Zang², Yun Guan^{1

6}

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA.
² Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100149, China.
³ McDonogh School, Owing Mills, Maryland, 21117, USA.
⁴ Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, 100149, China.
⁵ Department of Orthopedics, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA.
⁶ Department of Neurological Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD, 21205, USA.

Abstract

Chronic pain after spine surgery (CPSS) is often characterized by intractable low back pain and/or radiating leg pain, and has been reported in 8-40% of patients that received lumbar spine surgery. We conducted a literature search of PubMed, MEDLINE/OVID with a focus on studies about the etiology and treatments of CPSS and low back pain. Our aim was to provide a narrative review that would help us better understand the pathogenesis and current treatment options for CPSS. This knowledge will aid in the development of optimal strategies for managing postoperative pain symptoms and potentially curing the underlying etiologies. Firstly, we reviewed recent advances in the mechanistic study of CPSS, illustrated both structural (e.g., fibrosis and scaring) and non-structural factors (e.g., inflammation, neuronal sensitization, glial activation, psychological factor) causing CPSS, and highlighted those having not been given sufficient attention as the etiology of CPSS. Secondly, we summarized clinical evidence and therapeutic perspectives of CPSS. We also presented new insights about the treatments and etiology of CPSS, in order to raise awareness of medical staff in the identification and management of this complex painful disease. Finally, we discussed potential new targets for clinical interventions of CPSS and future perspectives of mechanistic and translational research. CPSS patients often have a mixed etiology. By reviewing recent findings, the authors advocate that clinicians shall comprehensively evaluate each case to formulate a patient-specific and multi-modal pain treatment, and importantly, consider an early intraoperative intervention that may decrease the risk or even prevent the onset of CPSS.

Translational potential statement: CPSS remains difficult to treat. This review broadens our understanding of clinical therapies and underlying mechanisms of CPSS, and provides new insights which will aid in the development of novel mechanism-based therapies for not only managing the established pain symptoms but also preventing the development of CPSS.

Keywords: Animal models; Chronic pain after spine surgery; Failed back surgery syndrome; Low back pain; Peripheral nervous system; Sensitization.

Publication types

Review