SOCIO-PSYCHOLOGICAL FACTORS AS PREDICTORS OF PAIN CHRONICITY: A CASE SERIES OF THREE PATIENTS WITH MULTILEVEL SPINAL DISORDERS

A. Telesca, G. Mazzaglia, M. Consonni, M. Gemma | Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano

BACKGROUND AND AIM
Post-surgical neuropathic pain is a challenging syndrome to treat due to the complex interplay of biological, psychological, and social factors that remain partially understood. Although the transition from acute to chronic pain is unclear, prior research has identified psychological risk factors—such as adverse life events, mood disorders, negative thinking, and psychopathologies—as key contributors to chronic post-surgical neuropathic pain (CPNP). This exploratory case series describes the long-term psychological trajectories of 3 patients (2 females, 1 male; mean age 52.3 ± 17.21 years) undergoing surgery for distinct spinal pathologies with complex multilevel involvement at two spinal levels.
METHODS
Psychological and pain assessments were conducted using the 10-point Numerical Rating Scale (NRS), mood status (Hospital Anxiety and Depression Scale – HADS), quality of life (EuroHis-QOL), catastrophizing thinking (Pain catastrophizing scale – PCS-I), and perceived mental (SF-12M) and physical health (SF-12P). Clinical interviews explored possible pre-operative expectations, psychiatric disease and/or psychological trauma in anamnesis. Evaluations were performed at 4 time points: pre-surgery (T0), early post-operative phase (T1), and follow-up at 3 (T2) and 6 months (T3). Intra- and post-operative pain management related parameters were also collected.
RESULTS
The clinical diagnoses were: (1) bilateral isthmic spondylolysis with grade II L5 spondylolisthesis (Case 1), (2) spinal neurinoma (Case 2), and (3) cervical compression neuropathy (C5–C7) (Case 3). All patients had prior psychiatric illness but no history of psychological trauma. Case 1 did not develop chronic pain; Cases 2 and 3 showed persistent symptoms. In Case 2, NRS scores increased from 1.5 to 4.0, indicating worsening pain. Case 3 showed a slight decrease from 8.0 to 7.0, with consistently high levels. Despite previous psychiatric illness, Case 1 showed protective factors—good cognitive-emotional baseline, younger age, and higher education—which may have prevented pain chronification. Case 2 had several risk factors: older age, longer illness, depression history, poor mental health, mood alterations at T0, and low pre-op engagement, likely contributing to partial persistence. Case 3 also showed high risk: older age, low education, prior depression, and catastrophizing, combined with poor overall health, leading to the most severe chronic pain outcome. All patients underwent general anesthesia (TIVA-TCI with propofol and remifentanil). Intraoperative analgesia included paracetamol, NSAIDs, and morphine. Local wound infiltration was used in Cases 1 and 2, not in Case 3. Case 1 also received ketamine (0.5 mg/kg) at induction like multimodal and opioids sparing approach. Post-operative pain common therapy was paracetamol and NSAIDs. Tapentadol was used in case 1 and 2 like rescue.
CONCLUSIONS
Although the influence of the underlying diagnosis on chronic pain trajectories may clearly play a prominent role, our findings suggest that psychological factors (psychiatric history, mood disturbances, maladaptive cognition) may significantly contribute to CPNP development. A larger sample will be necessary to accurately characterize these trajectories, accounting for diagnostic variability and pharmacological impact. Such data could help identify multimodal and personalized pain management strategies that integrate psychological and pharmacological approaches.