Optimistic disposition may reduce pain in patients who undergo spine surgery

May 9 2011
Individuals who are considering spinal surgery to relieve pain related to a herniated disc in the neck may be interested in the results of a new study, which found that mental outlook has a significant impact on post-operative quality of life. 

Some of the biggest concerns facing prospective spine surgery patients are related to the length and challenges of recovery, and the pain that may accompany the process. While there are some options - such as minimally invasive surgery - that can help reduce discomfort in the weeks after the operation, not all patients qualify for this type of procedure or have access to it.

The study conducted by researchers at Boulder Neurosurgical Associates and the University of Colorado at Boulder focused on a procedure called anterior cervical discectomy and fusion (ACDF), which is a traditional surgical therapy option for conditions related to the degeneration of the bones or joints of the cervical spine.

During the procedure, the surgeon accesses the targeted area through an incision near the front of the neck. He or she then removes the disc that presses on nerves and causes pain, and replaces it with a bone graft or an implant to fuse the vertebrae above and below, and stabilize the spine.

As the recovery from the procedure may involve some pain, the Colorado researchers set out to investigate the relationship between the patient's mental health - specifically their expectations of pain - and the surgical outcome.

For the purposes of the study, the researchers enrolled 79 patients who underwent ACDFs. They asked the subjects to rate their expected neck and arm pain using a scale from 0 to 10. The participants were also asked to complete neck disability, overall health and patient satisfaction surveys.

An average of 40 months after the surgery, the scientists noted that while overall health scores didn't substantially differ, the patients who had expected no pain reported lower neck and arm pain and higher mental health ratings than those who had previously said they did not believe their pain would resolve completely.

"This study clearly demonstrates the effect of patient mental health and optimism on clinical outcomes," said Alan T. Villavicencio, MD, one of the study's authors, adding that "[it] also suggests that meeting patient expectations in terms of pain relief is less important than their outlook and optimism."

However, he also cautioned against setting unrealistic expectations, stressing that patients and doctors should have a thorough and honest discussion about what to expect post-surgery, and treat mental health interventions as a possible adjunctive therapy.

Health experts warn that factors such as age, injury, poor posture or diseases such as arthritis may increase the risk of spine problems related to disc degeneration, herniation or bone spurs.

The study was presented at the 79th Annual Scientific Meeting of the American Association of Neurological Surgeons (AANS) in Denver. The organization says that neurosurgeons currently perform more spine operations than any other procedure type.