Alexithymia in Chronic Lumbar Radicular Pain: A Comparative Study of Failed Back Surgery Syndrome and Lumbar Disc...

BACKGROUND Failed back surgery syndrome (FBSS) involves persistent pain after surgery, with psychosocial factors contributing to symptom burden. Alexithymia is associated with chronic pain, but whether it is surgery-related or a broader feature of chronic lumbar radicular pain is unclear. We compared alexithymia between FBSS and non-surgical lumbar disc herniation (LDH). MATERIAL AND METHODS This cross-sectional study included 150 patients: FBSS after 1 surgery (n=64), FBSS after multiple surgeries (n=42), and magnetic resonance imaging-confirmed non-surgical LDH (n=44). Pain, disability, alexithymia, anxiety, and depression were assessed using the visual analog scale, Oswestry Disability Index, 20-item Toronto Alexithymia Scale, and Hospital Anxiety and Depression Scale. The primary analysis compared combined FBSS (n=106) with LDH (n=44); secondary analyses examined surgery-related variables. Correlation analyses and exploratory logistic regression were performed. RESULTS Patients with FBSS had greater disability and more frequent neurological and functional impairments than patients with LDH. Alexithymia prevalence did not differ significantly between groups and was unrelated to number of surgeries, fixation material, or time since first operation. Alexithymia scores correlated with pain, disability, anxiety, depressive symptoms, and sociodemographic factors. In exploratory logistic regression, HADS total score was independently associated with definite alexithymia; however, this finding warrants caution because events were limited and no predictive or causal inference can be made. CONCLUSIONS Alexithymia showed no surgery-specific difference between FBSS and LDH and may represent a broader psychosocial correlate of chronic lumbar radicular pain. Psychosocial assessment should be considered in surgical and non-surgical populations, although outcome benefits require further study.