Study: FEAR, Not Pain, Causing Problems With Spine Surgery

Coping skills…undertaught and underused. And when it comes to pain and function following spine surgery, it can be THE thing that makes a difference. A new and unusual study has found that using cognitive-behavioral based physical therapy (CBPT) has a good chance of helping patients decrease a nearly debilitating fear of movement after lumbar spine surgery.

In a randomized controlled trial, Matthew McGirt, M.D., adjunct associate professor at University of North Carolina and a practicing neurosurgeon with Carolina Neurosurgery and Spine Associates, worked with colleagues at Vanderbilt University to determine if CBPT could enhance quality of life and minimize pain-related disability. Dr. McGirt told OTW, “When I was at Vanderbilt I got to know Kristin Archer, Ph.D., D.P.T. a physical therapist who became very interested in the relationship between chronic pain and coping skills, and in fact spearheaded this research. We knew that outcomes following spine surgery are multifactorial. You are not only dealing with bone on bone degeneration on an MRI; the issue is cognitive, behavioral, and if affected by opioid dependence.”

Dr. Archer told OTW, “While working as a physical therapist I noticed that patients with chronic back pain who had undergone spine surgery kept coming back for more physical therapy. When I ended up having back surgery I had a very hard recovery; that led me to wonder about the relationship between pain and coping skills.”

Dr. Archer began collaborating with Stephen Wegener, Ph.D., director of the Division of Rehabilitation Psychology and Neuropsychology at Johns Hopkins. Drs. Archer and Wegener conducted a study where they found that individuals with chronic pain undergoing spine surgery had high fear of movement, tend to catastrophize, and are burdened with low self-confidence.

Dr. Archer continued, “We randomized 86 adults to have either CBPT or an educational program where we taught patients how to sit, walk, stand, etc. We learned that the ability to maximize quality of life and minimize pain-related disability is partly due to one’s psychological ability to cope with worry. It was surprising to find that the pain itself was not the main driver. Even though these patients’ pain was actually low, the FEAR was what caused the problems. These people were limiting their existence because they were worried about hurting themselves.”

“Because some patients are in a place of fear they do not hear what the surgeon has to say about what they can expect. It is important to repeat this information after surgery. In our program, we focused on helping patients with positive self-talk and goal setting. We are now doing a larger study involving 260 patients and recruiting patients at Vanderbilt and Johns Hopkins.

Dr. McGirt added, “Surgery addresses the structural disease, but there is also a patient’s ability to deal with the fear. For patients who have small pain generators, but poor coping mechanisms, the impact of the disease can be much more. We are missing an opportunity if we only address the structural pain generators.”