Chronic pain and psychological pain in the form of depression and/or anxiety commonly go hand-in-hand. Aside from the obvious situational relation – chronic pain can reduce one’s quality of life – psychological conditions can actually cause pain to worsen and persist, leading to a self-perpetuating and -escalating cycle. Psychological and physical pain share many areas of the brain and many chemical messengers, and this is believed to serve as the biological link between the two.
The connection between physical and mental well-being is important for any pain patient to know, as this information can help patients recover by encouraging them to address psychological factors of pain. It’s of particular interest to the minority of back pain patients who require surgery, as a failure to address psychological factors can worsen the prognosis of spinal surgery recovery.
There is some evidence behind this concern. A 2012 study, for example, found that patients who tested post-operatively as having depression and “negative affect” experienced higher levels of pain and disability three months after surgery than those who with positive affect and no depression. See more on the study at http://www.ncbi.nlm.nih.gov.
The researchers who conducted the above study concluded that post-operative psychological intervention may be important for certain patients recovering from spinal surgery. The United States Preventive Services Task Force actually goes a step further, recommending that patients undergo presurgical psychological screening.
If patients are found to have high levels of depression, anxiety or fear avoidance, it may be in their best interest to delay surgery until psychological intervention, such as cognitive behavioral therapy, has been sought out. Some may go ahead with the surgery and immediately begin psychological intervention.
However, it is likely that most spine surgeons don’t call for presurgical psychological screening. Recently, a group of researchers administered a survey to 110 surgeons and found that only 37% of them ordered testing for depression, and 85% of the 37% tested for anxiety. Surgeons reported believing strongly in the role psychological factors play in different areas of recovery, including pain intensity, return to work and treatment adherence.
See more on this survey at http://www.ncbi.nlm.nih.gov.
If you’re a candidate for back surgery, don’t be afraid to request psychological screening. It’s in your best interest to cover all your bases and increase your odds of a successful recovery. Also worth noting is that, except for in emergency situations, spinal surgery is a last resort; if you haven’t tried psychological intervention as part of your treatment plan yet, you haven’t exhausted your other options. You might be surprised by how much cognitive behavioral therapy can increase quality of life; in turn, you may even experience reductions in pain and disability.
Don’t rush into surgery. Taking care of your mental and emotional well-being can be as important to back pain treatment as the physical side of things.