Can a patient’s optimism result in better surgical outcomes? And conversely, is it more likely a patient who is demoralized will have more post-operative challenges?
Dr. Andrew Block, a psychologist at Texas Back Institute, is certain that the answer to both of these questions is yes. This is not based on casual speculation. Dr. Block has been thoroughly researching these phenomena for more than 20 years. He has also been the subject of an earlier post in this space.
Psychological pre-screening of patients who are scheduled to undergo back surgery has become an important aspect in the determination of their “emotional fitness,” which has shown to correlate to positive or negative post-operative outcomes. As a researcher and the author of numerous articles and books on this subject, Dr. Block is an expert in this field.
“Our research has shown that about 40 percent of the spine surgeons in the United States use this type of psychological pre-screening,” he noted in a recent interview. “In addition to spinal surgery, this type of psychological workup is now being used in procedures such as bariatric surgery and organ transplant surgery. Psychologists are getting involved in pre-surgery screening for many types of procedures.”
These Pre-Surgery Indicators Suggest Better Outcomes
What does 20 years of data, collected in psychological pre-screenings, suggest to Dr. Block?
“It suggests that there are factors which can encourage success in these surgical procedures and there are those which can negatively impact the results of these procedures,” he noted. “One of the factors which we’ve found in positive results of the surgery is ‘patient activation or engagement.’ This is where the patient is actively involved in the process and is confident in the surgeon’s ability to help them recover. This type of patient has a plan to stick with the program – post-operative recovery and rehabilitation – even when the process begins to get tough.”
“Another important indicator for post-operative success is a patient who remains hopeful,” he said. “The person who is demoralized tends to have a harder recovery, whereas someone who has a positive attitude will likely recover quicker.”
“Whether the patient is active, or working before the procedure is another important factor,” he noted. “A patient who is working before the procedure is 10 times more likely to return to work than one who is not working at the time of surgery.”
“Being able to avoid pain medications as much as possible, before and after the procedure, is another important pre-screening indicator,” he said. “If a patient is consuming a great many pain medications, this can be a red flag.”
Factors Which Can Lead to Poorer Surgical Outcomes
“Demoralization in a patient – where there is hopelessness or some level of disability – can often suggest a less positive surgical outcome,” he said. “They feel they have no control of their lives. Demoralization is probably the most important indicator of a poor outcome.”
“This is separate from clinical depression, which is experienced by about 60 percent of the people with chronic pain. This can involve having eating and sleeping difficulties, not having much energy, cognitive issues and especially having no happiness or joy. It’s possible for someone to be depressed, but not demoralized. However, when a patient has both depression and demoralization, this bodes very badly for the surgical outcome.”
“Another negative indicator is a patient who tends to complain about a lot of physical ailments. This is someone who seems to have lots of different kinds of pain and have difficulty filtering out the serious from the less serious.”
“Anger is the most common emotion associated with someone who is in chronic pain and this is another potential challenge to post-operative recovery from surgery. People who score high on an anger test tend to do poorly with spinal surgery.”
Taking Action on Issues Discovered in the Pre-Screening
How do patients who are told they have psychological issues which must be corrected before they are ready for spine surgery typically respond?
“When patients are informed they have psychological issues which will tend keep them from achieving positive results from spine surgery, most realize these problems exist and will appreciate the surgeon or the psychologist sharing this information,” he said. “Everyone wants a positive outcome and want to give the surgery the best shot they have.”
“When I have this discussion, most patients will go to work on these issues to ensure they have a good surgical outcome. Of course, this doesn’t always happen. In some cases, the patient is determined to have the surgery, in spite of these risk factors. In this case, it is up to the surgeon to make the decision about whether to proceed or not.”
“Texas Back Institute has been very much a leader in using these psychological pre-screenings. This practice was one of the first in the country to include a psychologist and the screenings in their treatment of spine surgery patients.”
Psychological pre-screening is another way Texas Back Institute treats both the mind and the body of every surgical patient. If you are dealing with chronic back pain and would like an appointment with some of the best back specialists in the world, contact us.