Systematic review of change in bodily pain after sinus surgery

Abstract

Objectives: To determine whether bodily pain is increased in patients with chronic rhinosinusitis (CRS) and if bodily pain improves following endoscopic sinus surgery (ESS).

Methods: All studies reporting results of more than 10 adult patients analyzing the response of bodily pain to ESS were retrieved by searching MEDLINE, EMBASE, Web of Science, Cochrane databases, and additional web-based sources (from January 1, 1980, to May 1, 2008); by examining bibliographies of retrieved articles; and by contacting investigators in the field.

Results: Of 279 ESS symptom outcome studies, only studies measuring results using the 36-Item Short Form Health Survey (SF-36) quality-of-life survey instrument measured bodily pain. Eleven observational ESS studies (1019 patients) reported mean preoperative SF-36 bodily pain scores at 0.89 SD below general population norms (24% more severe bodily pain than general population norms) and significantly below norms for a population 25 years older. Using a repeated-measures design, nine of 11 studies noted significant improvement in SF-36 bodily pain domain scores following ESS, with a moderate-sized combined effect of 0.55 (95% confidence interval, 0.45-0.64; I(2) = 44%) using the fixed-effects model. This pooled effect corresponded to a mean improvement of 11.8 U on the SF-36 bodily pain domain scale.

Conclusions: Bodily pain is increased in patients with CRS awaiting ESS, exceeding the normative bodily pain scores of a general normative population 25 years older. Using within-subject comparisons, a clinically and statistically significant improvement in bodily pain is noted after ESS, an improvement similar to that previously described for fatigue.

Figure 1

Study selection. SF-8 = 8-Item Short Form Health Survey; SF-12 = 12-Item Short Form Health Survey SF-36 = 36-Item Short Form Health Survey

Figure 2

Preoperative and postoperative SF-36 bodily pain symptom scores. Vertical bars indicate national or local general population SF-36 bodily pain normative values. Brackets indicate SDs.

Figure 3

Comparisons between preoperative SF-36 bodily pain scores in studies–, – using US SF-36 bodily pain score norms and normative values for different age groups and different diseases. Brackets indicate SDs. Abreviation: HT indicates hypertension; CRS pre-ESS indicates values for patients with chronic rhinosinusitis before endoscopic sinus surgery. *Chronic rhinosinusitis patients before endoscopic sinus surgery vs. general US normative values (P<.001). ** Chronic rhinosinusitis patients before endoscopic sinus surgery vs. US normative values for people 65 to 74 years of age (P<.001).

Figure 4

Changes in SF-36 bodily pain scores following endoscopic sinus surgery. Abbreviation: SF-36, 36-Item Short Form Health Survey. Data are given as standardized mean difference (95% confidence interval) unless otherwise indicated. Positive estimates favor decreased bodily pain following endoscopic sinus surgery. Effect size was defined as the standardized mean difference (Cohen d). See “Methods” section for further details. Cochran Q test was used to measure heterogeneity.