{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:47:36Z","timestamp":1792043256938,"version":"4.4.0"},"reference-count":36,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2026,11]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Preoperative risk stratification to identify patients who develop acute refractory pain after lumbar spine surgery is a first step to prevent unfavorable outcomes. In this study, we aimed to develop and internally validate a clinically relevant, multidimensional prediction rule for preoperative risk assessment.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This is a retrospective analysis of prospectively collected data conducted at an orthopedic hospital specialized in spine care. Baseline and outcome data on patients who underwent lumbar spine surgery between July 2012 and December 2022 were included in this study. 105 factors were considered as potential predictive factors for acute refractory pain after lumbar spine surgery. Multivariable logistic lasso regression analysis and multivariable logistic regression analysis were performed to develop a prediction model. Performance measures (ROC\u2010AUC and Nagelkerke's\n R<\/jats:italic>\n 2<\/jats:sup>\n ) and a prediction rule for clinical use were presented.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Data on 1156 patients was included in this analysis. The prevalence of patients developing acute refractory pain was 19.6% (\n n<\/jats:italic>\n \u2009=\u2009228\/1156). Multivariable logistic lasso regression identified 13 relevant predictive factors for acute refractory pain after lumbar spine surgery: age, prior hospital treatment for back pain, professional sports participation, duration of back pain, back pain before age 45, numeric pain rating scale for back pain, preoperative opioid use, circumferent surgery, instrumented surgery, anxiety, catastrophizing, return\u2010to\u2010work attitude, high score for psychosocial burden of low back pain. Five of these were selected by logistic regression. The discriminative ability of the multivariable logistic lasso regression model was ROC\u2010AUC of 0.69 (95% CI 0.66\u20130.73), and the multivariable logistic regression model 0.67 (95% CI 0.63\u20130.71). Nagelkerke's\n R<\/jats:italic>\n 2<\/jats:sup>\n of the logistic regression model was 8.4%.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Multidimensional predictive factors for acute refractory pain were identified using a clinical prediction rule. This rule creates a patient profile which can help anesthesiologists to preoperatively determine the individual risk for developing acute refractory pain despite the use of a standardized multimodal analgesic treatment.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/papr.70213","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T05:13:44Z","timestamp":1792041224000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and Validation of a Clinical Prediction Rule to Identify Preoperatively Patients With Acute Refractory Pain After Lumbar Spine Surgery"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2657-4294","authenticated-orcid":false,"given":"Ilse H.","family":"van de Wijgert","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Sint Maartenskliniek Nijmegen the Netherlands"},{"name":"Department of Anesthesiology, Pain and Palliative Medicine Radboud University Medical Center Nijmegen the Netherlands"},{"name":"Department of Research Sint Maartenskliniek Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2919-6356","authenticated-orcid":false,"given":"Kris C. P.","family":"Vissers","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Sint Maartenskliniek Nijmegen the Netherlands"},{"name":"Department of Anesthesiology, Pain and Palliative Medicine Radboud University Medical Center Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn W.","family":"Heymans","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics VU University Medical Center Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6145-1767","authenticated-orcid":false,"given":"Akkie","family":"Rood","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery Sint Maartenskliniek Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moniek","family":"de Goeij","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Sint Maartenskliniek Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0962-2944","authenticated-orcid":false,"given":"Regina L. M.","family":"van Boekel","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Pain and Palliative Medicine Radboud University Medical Center Nijmegen the Netherlands"},{"name":"Research Department of Emergency and Critical Care HAN University of Applied Sciences Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5313-6436","authenticated-orcid":false,"given":"Miranda L.","family":"van Hooff","sequence":"additional","affiliation":[{"name":"Department of Research Sint Maartenskliniek Nijmegen the Netherlands"},{"name":"Department of Orthopedic Surgery Radboud University Medical Center Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_2_13_2_1","article-title":"Insufficient Pain Management After Spine Surgery","volume":"61","author":"Nielsen R. V.","year":"2014","journal-title":"Danish Medical Journal"},{"key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1097\/ALN.0b013e31828866b3","article-title":"Pain Intensity on the First Day After Surgery","volume":"118","author":"Gerbershagen H. J.","year":"2013","journal-title":"Anesthesiology"},{"key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/ALN.0000000000004037","article-title":"Pain and Opioid Consumption and Mobilization After Surgery: Post Hoc Analysis of Two Randomized Trials","volume":"136","author":"Rivas E.","year":"2022","journal-title":"Anesthesiology"},{"key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"155","DOI":"10.21037\/jss.2017.04.04","article-title":"Effects of Immediate Post\u2010Operative Pain Medication on Length of Hospital Stay: Does It Make a Difference?","volume":"3","author":"Elsamadicy A. A.","year":"2017","journal-title":"Journal of Spine Surgery"},{"key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1097\/EJA.0000000000000319","article-title":"Chronic Postsurgical Pain in Europe: An Observational Study","volume":"32","author":"Fletcher D.","year":"2015","journal-title":"European Journal of Anaesthesiology"},{"key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1016\/S0140-6736(06)68700-X","article-title":"Persistent Postsurgical Pain: Risk Factors and Prevention","volume":"367","author":"Kehlet H.","year":"2006","journal-title":"Lancet"},{"key":"e_1_2_13_8_1","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1097\/ACO.0000000000000765","article-title":"Anesthetic Management of Complex Spine Surgery in Adult Patients: A Review Based on Outcome Evidence","volume":"32","author":"Alboog A.","year":"2019","journal-title":"Current Opinion in Anaesthesiology"},{"key":"e_1_2_13_9_1","first-page":"930","article-title":"Best Evidence in Multimodal Pain Management in Spine Surgery and Means of Assessing Postoperative Pain and Functional Outcomes","volume":"22","author":"Devin C. J.","year":"2015","journal-title":"Current Opinion in Anaesthesiology"},{"key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jpain.2015.12.008","article-title":"Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council","volume":"17","author":"Chou R.","year":"2016","journal-title":"Journal of Pain"},{"key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1177\/0963689718796072","article-title":"Narcotic Addiction in Failed Back Surgery Syndrome","volume":"28","author":"Chen Y. C.","year":"2019","journal-title":"Cell Transplantation"},{"key":"e_1_2_13_12_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.3171\/2020.5.SPINE20347","article-title":"Development and Validation of a Clinical Prediction Score for Poor Postoperative Pain Control Following Elective Spine Surgery","volume":"34","author":"Yang M. M. H.","year":"2021","journal-title":"Journal of Neurosurgery. Spine"},{"key":"e_1_2_13_13_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-025091","article-title":"Preoperative Predictors of Poor Acute Postoperative Pain Control: A Systematic Review and Meta\u2010Analysis","volume":"9","author":"Yang M. M. H.","year":"2019","journal-title":"BMJ Open"},{"key":"e_1_2_13_14_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0104226","article-title":"The Nijmegen Decision Tool for Chronic Low Back Pain. Development of a Clinical Decision Tool for Secondary or Tertiary Spine Care Specialists","volume":"9","author":"Hooff M. L.","year":"2014","journal-title":"PLoS One"},{"key":"e_1_2_13_15_1","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.amjsurg.2010.02.007","article-title":"Catastrophizing: A Predictive Factor for Postoperative Pain","volume":"201","author":"Khan R. S.","year":"2011","journal-title":"American Journal of Surgery"},{"key":"e_1_2_13_16_1","unstructured":"H.Yun V.Ip M. B. B.Ch et\u00a0al. \u201cPredictors of Postoperative Pain and Analgesic Consumption A Qualitative Systematic Review \u201d(2009)."},{"key":"e_1_2_13_17_1","doi-asserted-by":"crossref","first-page":"g7594","DOI":"10.1136\/bmj.g7594","article-title":"Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD): The TRIPOD Statement","volume":"350","author":"Collins G. S.","year":"2015","journal-title":"BMJ"},{"key":"e_1_2_13_18_1","first-page":"1","article-title":"Can Patient\u2010Reported Profiles Avoid Unnecessary Referral to a Spine Surgeon? An Observational Study to Further Develop the Nijmegen Decision Tool for Chronic Low Back Pain","volume":"13","author":"Hooff M. L.","year":"2018","journal-title":"PLoS One"},{"key":"e_1_2_13_19_1","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/978-1-4614-7138-7_3","volume-title":"An Introduction to Statistical Learning: With Applications in R","author":"James G.","year":"2013"},{"key":"e_1_2_13_20_1","doi-asserted-by":"crossref","DOI":"10.3389\/fepid.2022.975380","article-title":"Modeling Non\u2010Linear Relationships in Epidemiological Data: The Application and Interpretation of Spline Models","volume":"2","author":"Schuster N. 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