The Impact of Preoperative Mindfulness-Based Stress Reduction on Postoperative Patient-Reported Pain, Disability, Quality of Life, and Prescription Opioid Use in Lumbar Spine Degenerative Disease: A Pilot Study Juneyoung L. Yi 1 , Christina A. Porucznik 3 , Lisa H. Gren 3 , Jian Guan 1 , Evan Joyce 1 , Darrel S. Brodke 2 , Andrew T. Dailey 1 , Mark A. Mahan 1 , Robert S. Hood 1 , Brandon D. Lawrence 2 , William R. Spiker 2 , Nicholas T. Spina 2 , Erica F. Bisson 1 - BACKGROUND: Prescription opioid medications nega- tively affect postoperative outcomes after lumbar spine surgery. Furthermore, opioid-related overdose death rates in the United States increased by 200% between 2000 and 2014. Thus, alternatives are imperative. Mindfulness-based stress reduction (MBSR), a mind-body therapy, has been associated with improved activity and mood in opioid- using patients with chronic pain. This study assessed whether preoperative MBSR is an effective adjunct to standard postoperative care in adult patients undergoing lumbar spine surgery for degenerative disease. - METHODS: The intervention group underwent a preop- erative online MBSR course. The comparison group was matched retrospectively in a 1:1 ratio by age, sex, type of surgery, and preoperative opioid use. Prescription opioid use during hospital admission and at 30 days postoperatively were compared with preoperative use. Thirty-day postoperative patient-reported outcomes for pain, disability, and quality of life were compared with preoperative patient-reported outcomes. Dose-response effect of mindfulness courses was assessed using Mind- ful Attention Awareness Scale scores. - RESULTS: In this pilot study, 24 participants were included in each group. Most intervention patients (70.83%) completed 1 session, and the mean Mindful Attention Awareness Scale score was 4.28  0.71 during hospital admission. At 30 days, mean visual analog scale back pain score was lower in the intervention group (P [ 0.004) but other patient-reported outcomes did not differ. - CONCLUSIONS: During hospital admission, no signifi- cant dose-response effect of mindfulness techniques was found. At 30 days postoperatively, MBSR use was associ- ated with less back pain. Further research is needed to assess the effectiveness of preoperative MBSR on postoperative outcomes in lumbar spine surgery for degenerative disease. INTRODUCTION A s the U.S. population ages, the prevalence of surgeries for lumbar degenerative disease will likely continue to in- crease. 1-4 Prescription opioid medications are a mainstay for perioperative pain control in patients who have undergone spine surgery; however, multiple studies have shown that their use has a negative impact on postoperative outcomes. 5-7 Furthermore, from the public health perspective, the population-level harm associated with opioids in the United States has increased because of the increasing rate of addiction and associated deaths. 8,9 Thus, alternatives to prescription opioids are imperative. Key words - Degenerative disease - Lumbar spine surgery - Mindfulness-based stress reduction - Patient-reported outcomes - Prescription opioids Abbreviations and Acronyms MAAS: Mindful Attention Awareness Scale MBSR: Mindfulness-based stress reduction MED: Morphine-equivalent dosing PROMIS: Patient-Reported Outcomes Measurement Information System RCT : Randomized controlled trial VAS-BP: Visual analog scale back pain VAS-LP: Visual analog scale leg pain From the 1 Department of Neurosurgery, Clinical Neurosciences Center and 2 Department of Orthopaedic Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah; and 3 Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA To whom correspondence should be addressed: Juneyoung L. Yi, M.D., M.S.P.H. [E-mail: June.Yi@hsc.utah.edu] Citation: World Neurosurg. (2018). https://doi.org/10.1016/j.wneu.2018.09.223 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2018 Elsevier Inc. All rights reserved. WORLD NEUROSURGERY -: e1-e6, - 2018 www.WORLDNEUROSURGERY.org e1 Original Article