Can Psychological Support Help With Back Pain?

Pain can be very difficult to control and sometimes, even after many months of treatment, the patient may still suffer from pain. This can have many deleterious effects on one’s life. It may affect one’s job, home and relationships with others. Back pain support from friends, family and co-workers is very important in this person’s time of need.

Sometimes this level of back pain support is not enough, and the patient may need help from a trained psychological professional. With the help of the psychological professional, patients may be able to explore in-depth how back pain is affecting life and relationships. Other services that a psychological interventionist may be able to provide include pre-surgical psychological screening, general psychological evaluation and treatments such as biofeedback and hypnotherapy.

A referral to a psychologist should not be viewed as a sign that the care provider thinks that the patient is crazy or that the patient is making up the problem. It should be viewed as a sign that there is an appreciation for how stressful back pain can be, as well as another possible means to help the patient control pain. Psychological treatment for back pain support may also help patients to have a realistic view of their spinal condition and the planned treatments.


When is Back Pain Support Needed?

Patients facing major spine surgery, those with failed spine surgery syndrome, and those with chronic pain may benefit from psychological support, especially if experiencing :

  • Depression
  • Anxiety
  • Anger and irritability
  • Dependence on pain medication
  • High levels of Stress
psychological screening

What does Psychological Back Pain Support Involve?

  • The first visit with the psychologist involves an interview and completion of questionnaires.  The first visit explores the effects of pain on the  patient’s life, emotional difficulties, stress, worries, past emotional difficulties, medication use and expectations for treatment
  • Many patients complete a pre-surgical psychological evaluation.   This is a very common part of our holistic approach and helps us to better understand and tailor treatments to each patient.   This session will explore your concerns and expectations about the surgery, the ways in which you have tried to deal with the pain and efforts you have made to improve, your use of medications, how the spine problems have affected your life, and how others have reacted to your back problems. 
  • The psychologist may help the patient with pain control (using techniques such as meditation or hypnosis) and may provide techniques to help overcome depression and anxiety related to pain.

Before Surgery

  1. Learn as much as you can about the physical conditions causing your spine pain and limiting your activities.  
  2. Make sure you that you have explored other options and that you feel confident that surgery is the best option for your condition
  3. Discuss your understanding your physical condition and your surgery with the surgeon, so that you are working together.  Come prepared to ask the surgeon any questions you may have.
  4. Learn about actions you can take to prepare for the surgery such as proper nutrition and exercise.
  5. Get sufficient sleep.
  6. Examine your emotions and discuss any negative feelings such as depression, anxiety, stress or anger with a qualified mental health professional.  Negative emotions can lead to poor surgery results
  7. Limit narcotic intake prior to surgery as much as possible.  Long-term use of high levels of narcotics makes post-operative pain control more difficult to achieve and is associated with poor surgery results.  Discuss any problems you have had with narcotic medications with your physician
  8. Keep as active as you can prior to surgery.  Keep working if possible.  Inactivity causes your muscle weakness, decreased endurance, and you lose important aspects of your life.
  9. Learn realistic expectations for the results of spine surgery, including how much pain relief to expect, how much you can expect to improve your abilities to engage in activities, whether you can return to work, etc.  Do not set yourself up for disappointment by expecting more of the surgery than it can deliver
  10. Recognize that surgery only creates the foundation for your recovery and healing.  Where the surgery takes you depends on your own efforts to be as healthy as possible.
  11. Determine what arrangements will be needed for your post-operative care, if necessary.  Involve family members in appointments with your physician and in care planning so that they can best understand and promote your healing process.

After Surgery

  1. Seek balance between activity and rest.  Push yourself to gain strength and endurance but be aware of pain, and let it act as your guide.  Do not undertake activities (especially during the initial post-op period) that you know will cause a major increase in pain.  Do not undertake activities that you know you can only do if you take pain medication.
  2. Recognize that healing is unlikely to be rapid or easy, and will involve setbacks.  Commit yourself to staying positive and pushing for improvement even when it is difficult.  Do not blame yourself when your recovery is not going as you expect.
  3. Make healing your work.  Do not feel guilty that you can not do your normal job, or do household tasks, as you recover from the surgery.  Accept that you have limitations while you heal.
  4. Examine what’s important to you and commit yourself to it, while adapting to any limitations you experience.
  5. If you were taking antidepressant medication before surgery continue taking it for at least 4-6 months post-op even if you are feeling great.  Stopping an antidepressant during the post-operative period can cause you to become depressed and negatively affect your recovery.
  6. Accept help and support from others.  Don’t let pride or habit lead you to undertake activities when others would gladly assist you.  Don’t forget to give them support, also.  
  7. View surgery not as an end of pain, but as a beginning—a resetting of the foundation for you to regain health and vitality
  8. Set goals for your recovery, but stay flexible.  Some goals may need to be delayed, others may need to be abandoned.  View changing your goals as a victory for your ability to adapt.

Pre-Surgery Questions

  1. What type of surgery are you recommending? Why?
  2. What is the source of the pain that is being addressed? How do you know this?
    Exploratory surgery is never done on the back.
  3. Please explain the procedure in great detail.
    The amount of information depends on your personal preferences. Some patients want to know everything, some not so much!
  4. What are my non-surgical options?
  5. What is the natural course of my condition if it is not surgically addressed?
  6. What would you recommend if I was your friend or loved one?
  7. How long will the surgery take?
  8. What are the side effects, potential risks, and potential complications?
  9. Please explain the risks and how they relate to me personally.
    For example, different risk factors like smoking, being overweight or having grade 3 spondylolisthesis, etc, will affect surgical outcomes.
  10. What if, during my surgery, you encounter a different spine issue than you expected?
  11. Do I need to donate my own blood? If yes, why?
    For most types of back surgery, blood does not need to be donated ahead of time.
  12. Do you perform the whole procedure? Will any students and/or other surgeons be doing any parts of the operation? If yes, who are they and what are their qualifications?
  13. Who else will assist you in the operation? What are their background and qualifications?
  14. What are the long-term consequences of the proposed procedure?
    For example, will the operation ever need to be re-done? If it is a fusion, will it lead to degeneration at other levels of the spine?

Questions About the Surgeon

  1. How many times have you done this procedure?
    Generally, when it comes to surgery, “practice makes perfect,” so more experience is better.
  2. Are you board eligible or board certified?
    You can usually look on the wall and see a certificate.
  3. Are you fellowship trained in spine surgery?
    This is more important if the surgery is a fusion, artificial disc replacement, or other more extensive procedure.
  4. If I want to get a second opinion, who would you recommend?
    The recommendation should be someone not in the same practice.
  5. Statistically, what is the success rate for this type of surgery? What is your personal success rate, and how many of this type of surgery have you done?
  6. Can I talk to other patients who have had a similar procedure?
    The patient will have to sign a HIPAA release form, but typically, happy patients want to share their success stories.

Any defensiveness on the part of the surgeon when you ask these types of questions may be a red flag. A surgeon with good results and appropriate qualifications will not be threatened by these types of questions and will respect your attention to these matters.

Post-Surgery Questions

  1. What kind of pain should I expect after the surgery and for how long?
  2. How long is the hospital stay?
  3. May a family member spend the night with me in the hospital?
  4. How do you manage the pain in the hospital?
  5. Which pain medications will I be sent home with? What are possible side effects of these prescriptions (e.g. constipation, drowsiness, etc.)?
  6. Will you know before the surgery if I will need a back brace afterwards? If so, will I be fitted for one before the surgery?
  7. Will I need any other medical equipment (like a walker) when I go home?
  8. Who can I call if I have questions after the surgery? What is the process for communication?
  9. How often will I see you after my surgery?
  10. What symptoms would warrant a call to your office?
  11. What symptoms would warrant immediate medical attention?
  12. What limitations will I have after surgery and for how long?
  13. How long should I wait to bathe?
  14. How long will I be out of work? School?
  15. What kind of help will I need when I return home?
  16. When can I drive again?
  17. When can I resume normal (light) household chores?
  18. What expectations do you have for my recovery?
  19. When is it safe to resume sexual relations?
  20. How soon after the surgery can I start physical therapy?
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