Anxiety and depression, making your back pain more chronic and harder to treat

We’ll try to keep short and sweet about what we’re reading. Here’s an old article that resonates pretty well: “Improved outcome after lumbar microdiscetomy in patients shown their excised disc fragments: A prospective, double blind, randomized, controlled trail.”

This was published in the journal of neurology, neurosurgery, and psychiatry in 2008. In this study, patients who underwent lumbar microdiscectomy, a procedure where herniated disc material is cleaned up from the spinal canal reducing nerve pressure. The patients were put into two categories. There were those that were given the removed fragments from their surgery and those that weren’t. Overall, both patients experienced relief but the patients that were given their disc fragments reported improvements in leg symptoms and back pain significantly more than the control group. There were also improvements in associated leg weakness and paraesthsia. This group also reported a reduced need to take pain medication sooner after the surgery. 

These are interesting findings that demonstrate how our mental state can affect our physical state. Anxiety and depression are common among patients presenting for back surgery and influence the duration of low back pain and the development of a more chronic condition. Preoperative anxiety or depression and passive pain coping strategies are well established negative prognostic indicators following lumbar microdiscectomy. Prognostic indicators are factors that influence how quick or slow someone will recover from an injury.

Unfortunately, clinicians forget this and opt to diagnose solely based on findings on MRI or X-ray. Poorly explained MRI or X-ray findings can lead patients to assume their condition has no hope of getting better. Think about the diagnosis, “degenerative disc disease.” The words alone are suggestive of a “disease” that can never improve. This leads many to assume that they “have a bad back.” This leads to some of the passive pain coping strategies that make back pain more chronic and harder to treat.

The most important factors are what we find during our clinical examination. Imaging does play a crucial role in the diagnosis and management of certain conditions, however, should never be solely relied on until conservative measures have been exhausted. If you need a second opinion regarding surgery, don’t hesitate to ask.

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