It may not be surprising that patients who fear the worst also claim that they experience the worst. A research group based in Australia and Denmark published a study showing that in the June 2020 issue of The Spine Journal. The authors of the study, “Catastrophization, fear of movement, anxiety, and depression are associated with persistent, severe low back pain and disability,” investigated the correlation of psychological characteristics with persistent low back pain. They assessed psychological factors such as: depression, fear of movement, anxiety, and catastrophization (a manifestation of anxiety characterized by the fear that something is far worse than reality), and physical effects of low back pain, and disability.
Linking Back Pain to Depression, Catastrophization and More
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Secondary#depression#anxiety#catastrophization
Nearly 1,000 individuals participated in the study, with about two-thirds completing the 1-year follow-up. Patients were screened at baseline for psychological conditions. Pain was assessed through an 11-point numeric rating scale and disability measured using the Roland-Morris disability questionnaire. Statistical analysis showed a relationship between all of the psychological characteristics and low back pain and disability, however, only catastrophization and depression were statistically significantly associated.
The results of the study are intriguing and may bring more attention to this growing field of study within spine and orthopedic surgery. Due to the substantial importance given to patient reported outcome measures in deciding to operate, it is critical to better understand the underlying psychological state that may impact perception of pain and disability, not to mention expectations of surgery.
Many surgeons and hospitals require a psychological evaluation prior to surgery to establish a patient’s desire for surgery and their expectations. The patient-reported outcomes and pain itself can be very subjective and depression may be considered disabling itself, so it is hard to draw conclusions from this study.
There is also potential selection bias due to the fact that only two-thirds of participants completing the study—perhaps those patients with little pain felt the need to continue. Finally, it is very difficult to draw a causal relationship between pain and disability to psychological dysfunction.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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