Older Patients More Accurately Predict Pain Tolerance After Lumbar Spine Fusion Compared with Their Younger Peers

Objective: Patients undergoing spine surgery often inaccurately estimate their pain tolerance and postoperative analgesic requirement. We sought to identify an association between patients' self-perceived pain tolerance and postoperative opioid consumption (POC).

Methods: We included adult patients undergoing elective lumbar spine decompression and fusion between 2014 and 2018. Patients with cognitive delay, psychiatric comorbidities, and perioperative complications were excluded. Demographic data, mean daily postoperative morphine milligram equivalents (MME), and pain tolerance scores were recorded.

Results: Eighty-four patients met inclusion criteria. The median pain tolerance score was 8, which was used to defined a cutoff for high (≥8) and low (<8) pain tolerance. The average preoperative visual analog scale (VAS) pain score was higher in the high pain tolerance group (μ = 5.3) compared with the low pain tolerance group (μ = 4.0) (P = 0.01). Multivariate regression revealed pain tolerance was not predictive of mean daily postoperative MME use (P = 0.19). Age and preoperative VAS pain score were found to be negative (P < 0.0001) and positive (P = 0.027) independent predictors, respectively, of mean postoperative MME use. Patients 61 years and younger who reported high pain tolerance had higher POC compared with patients older than 61 years of age, who reported low (P = 0.036) pain tolerance.

Conclusions: Self-perceived pain tolerance does not appear to predict POC, while younger age and higher preoperative VAS pain scores are related to increased POC. Younger patients who report high pain tolerance appear to consume higher levels of opioids compared with older patients.