Conference Coverage

Early Pain Burden Linked to Slower Recovery After Lumbar Fusion

Brian McCurdy

Key Highlights

  • Among 139 lumbar fusion patients, higher early postoperative pain burden was associated with poorer quality-of-life recovery at 90 days.
  • Patients with higher pain burden had significantly lower day-90 EQ-5D scores than those with lower pain burden.
  • Higher early pain burden and lower baseline quality of life were associated with lower day-90 EQ-5D scores in multivariable analysis.

Greater cumulative pain during the first week after lumbar spinal fusion was associated with delayed health-related quality-of-life (HRQoL) recovery at 90 days, according to research presented at the ANESTHESIOLOGY Annual Meeting 2026 in San Diego, California. The secondary analysis of a multicenter prospective cohort examined whether early postoperative pain burden predicted subsequent recovery.

Researchers included 139 adults undergoing lumbar spinal fusion. They assessed pain and HRQoL before surgery and on postoperative days 1, 3, 7, 14, 21, 30, 60, and 90 using the validated Brief Pain Inventory (BPI) and EQ-5D-5L.

Early pain burden was defined as the time-weighted average of BPI pain scores over postoperative days 1 through 7. Investigators calculated this measure using the trapezoidal rule to compute the area under the curve, then divided patients into high- and low-pain-burden groups based on the median. The primary outcome was the EQ-5D utility score at postoperative day 90. Multivariable linear regression evaluated factors associated with that outcome.

Study Findings

Across the cohort, HRQoL declined markedly after surgery and gradually recovered over the following 90 days. Patients in the high pain burden group had consistently worse recovery trajectories than those in the low pain burden group. At day 90, the high pain burden group had significantly lower EQ-5D scores, with a reported between-group mean difference of 0.104 (95% CI, 0.012–0.197; P = .028). The abstract’s figure description reported statistically significant differences in EQ-5D trajectories between groups at all assessed time points (P < .05).

In multivariable analysis, higher early pain burden was associated with lower day-90 EQ-5D scores (β = −0.032; 95% CI, −0.060 to −0.003; P = .032). Higher baseline EQ-5D scores were associated with higher day-90 scores (β = 0.192; 95% CI, 0.087–0.297; P < .001).

Clinical Implications

According to the study authors, cumulative early postoperative pain burden was associated with delayed HRQoL recovery after lumbar spine surgery. They suggested that early pain control may represent a modifiable target for improving longer-term postoperative recovery. The reported results describe an association between first-week pain burden and subsequent quality of life; the analysis did not establish that improving early pain control changes recovery outcomes.

Expert Commentary

“These findings suggest that early pain control may represent a modifiable target to improve longer-term postoperative recovery,” the researchers concluded.

Reference

Zhang Q, Wang H, Ma Y, Feng Y. Early postoperative pain burden predicts delayed quality of life recovery at 90 days after lumbar spine surgery. Abstract presented at: ANESTHESIOLOGY 2026; October 16-20, 2026; San Diego, CA. Abstract A1759.