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June 6, 2026Journal of Pain ResearchOpen Access

Postoperative chronic back pain syndrome's reported association with Parkinson's disease (aHR 1.40) is argued to be highly vulnerable to protopathic bias, pharmacological confounding, and differential surveillance.

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Population

603,272 patients undergoing lumbar spine surgery between 2009 and 2023 in a Korean nationwide cohort

Design

Editorial

Key result

Postoperative chronic back pain syndrome's reported association with Parkinson's disease (aHR 1.40) is argued to be highly vulnerable to protopathic bias, pharmacological confounding, and differential surveillance.

Authors

KŞKenan ŞimşekSHSerhat HızalMPMustafa Pehlıvan

Discussion

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Member takes

Overview

This letter raises methodological considerations regarding a recent study linking postoperative chronic back pain syndrome to adverse psychiatric, neurological, and mortality outcomes.

Key Points

  • The letter addresses the methodology used in a Korean nationwide cohort study linking postoperative chronic back pain syndrome to various health outcomes.
  • Review of a retrospective cohort study utilizing the Korean National Health Insurance Service database from 2009-2023.
  • Analysis involved 603,272 patients who underwent lumbar spine surgery.
  • Discussion of methodological considerations to improve interpretability of the reported associations.
  • Postoperative chronic back pain syndrome was linked to increased risks of psychiatric disorders (aHR 1.15), stroke (aHR 1.15), Parkinson's disease (aHR 1.40), dementia (aHR 1.07), and all-cause mortality (aHR 1.10).
  • A call for a shift in postoperative care based on these associations.

Structured PICO

P
Population
603,272 patients who underwent lumbar spine surgery between 2009 and 2023 in South Korea, evaluated for the association between postoperative chronic back pain syndrome and various outcomes.
E
Exposure
Postoperative chronic back pain syndrome (PCBPS)
O
Outcome
Psychiatric disorders, stroke, Parkinson's disease, dementia, and all-cause mortality

Main Result

Hazard Ratio: 1.4

This letter raises methodological considerations regarding a recent study linking postoperative chronic back pain syndrome to adverse psychiatric, neurological, and mortality outcomes.

Limitations

  • Protopathic bias and reverse causation regarding Parkinson's disease
  • Heterogeneity of the exposure definition merging distinct clinical entities
  • Pharmacological confounding by gabapentinoids
  • Differential outcome ascertainment (surveillance bias)
  • Missing key covariates such as preoperative psychiatric history and opioid use
  • Lack of sensitivity analyses for residual confounding (e.g., E-value framework)

Cite This Study

Şimşek et al. (2026) conducted a letter in Postoperative chronic back pain syndrome (n=603,272). Postoperative chronic back pain syndrome (PCBPS) vs. No PCBPS was evaluated on Parkinson's disease (aHR 1.40). Postoperative chronic back pain syndrome's reported association with Parkinson's disease (aHR 1.40) is argued to be highly vulnerable to protopathic bias, pharmacological confounding, and differential surveillance.

synapsesocial.com/papers/6a23bb4471a5da9775e76d3bhttps://doi.org/10.2147/jpr.s618208
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Chronic Postsurgical Pain-Induced Postoperative Anxiety Risk2025
  2. 2Incidence and preoperative risk factors for failed back surgery syndrome: a nationwide population-based cohort study2026
  3. 3Valuable Prognostic Role of Disability, Pain, Anxiety, and Depression Scales in Instrumented Lumbar Spine Surgery for Degenerative Pathology: The SAP-LD Study2025
  4. 4Factors Associated with the Decision to Undergo Spine Surgery2025
  5. 5Analysis of the relationship between lifestyle and postoperative cardiac and cerebrovascular complications after major abdominal surgery: a cohort study2025