Commentary on: Can the anxiety domain of EQ-5D and mental health items from SF-36 help predict outcomes after surgery for lumbar degenerative disorders? By Carreon et al.
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
- Center for Pain Treatment and Rehabilitation, Lake Forest Hospital, Lake Forest, Lake County, Illinois, USA
- North Shore Psychological Services, Creative Pain Solutions, Lake County, Illinois, USA
Ronald P. Pawl
North Shore Psychological Services, Creative Pain Solutions, Lake County, Illinois, USA
DOI:10.4103/2152-7806.194514Copyright: © 2016 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Pawl RP, Mahoney ND. Commentary on: Can the anxiety domain of EQ-5D and mental health items from SF-36 help predict outcomes after surgery for lumbar degenerative disorders? By Carreon et al.. Surg Neurol Int 21-Nov-2016;7:
How to cite this URL: Pawl RP, Mahoney ND. Commentary on: Can the anxiety domain of EQ-5D and mental health items from SF-36 help predict outcomes after surgery for lumbar degenerative disorders? By Carreon et al.. Surg Neurol Int 21-Nov-2016;7:. Available from: http://surgicalneurologyint.com/surgicalint_articles/commentary-on-can-the-anxiety-domain-of-eq%e2%80%915d-and-mental-health-items-from-sf%e2%80%9136-help-predict-outcomes-after-surgery-for-lumbar-degenerative-disorders-by-carreon-et-al/
The question in the title of this paper practically answers itself. Can the anxiety domain of EQ-5D and mental health items from SF-36 help predict outcomes after surgery for lumbar degenerative disorders? Yes, paper and pencil questionnaires (however brief) purporting to assess patients’ emotional status may contribute some small incremental value for predicting lumbar fusion outcomes. However, it has long been recognized that, as far as pain and function are concerned, predicting lumbar fusion outcomes is frustratingly difficult.
A historical perspective helps elucidate the problem. In the 1970s, there was a large surge of formation of comprehensive pain treatment centers, largely stimulated by the efforts at UVA (The University of Virginia) and the University of Washington. Neurosurgeons and Orthopedic surgeons, largely responsible for treating such conditions, were joined by anesthesiologists. The latter entered the arena of because of their experience with injections for pain. Together the spine surgeons and anesthesiologists formed multidisciplinary in-depth programs for the analysis and treatment of chronic pain conditions. This resulted in the formation of the International Association for the Study of Pain,[
Such multidisciplinary collaborations were made possible by a fundamental shift away from a purely biomedical model toward a broader biopsychosocial model (e.g. late 1970's).[
Much research has since addressed the relationship between preoperative emotional status and outcome of lumbar fusion surgery. Certainly, the psychological status of the patient is one of the major predictors of the outcomes of lumbar fusions.[
This study, therefore, offers little practical assistance to spine clinic personnel, who have no sophisticated psychological training. Nevertheless, many are increasingly charged with identifying depressed or anxious patients, and responsible for directing them toward preoperative psychological or behavioral counseling.
The current authors concluded “It is important to recognize that no single data point is likely to optimize patient selection.” Another recent study stated “there is not enough evidence to determine which psychological variables are influential in predicting outcomes for LSF (Lumbar Spinal Fusion.”[
To account for the remaining 80% of the variance in predicting lumbar fusion outcomes, we have to acknowledge that the interaction of multiple biopsychosocial elements contribute very heavily and must be considered when attempting to predict those patients most likely to benefit from lumbar fusions. Finally, while decades of group based research has been enlightening, the fundamental challenge is to pinpoint those individual patients in the clinic at risk for unsatisfactory outcomes in lumbar fusion surgery. Currently, the identification of simple and speedy methods for accurately predicting individual outcomes remains as elusive as ever.
1. Engel GL. The need for a new medical model: A challenge for biomedicine. Science. 1977. 196: 129-36
2. . Available at: http://www.iasppain.org/History?navItemNumber = 665.
3. Pawl R. When the pain won’t wane it's mainly in the brain. Surg Neurol Int. 2013. 13: S330-3
5. Trief PM, Ploutz-Snyder R, Fredrickson BE. Emotional health predicts pain and function after fusion: A prospective multicenter study. Spine. 2006. 31: 823-30
6. Wilhelm M, Reiman M, Goode A, Richardson W, Brown C, Vaughn D. Psychological Predictors of Outcomes with Lumbar Spinal Fusion: A Systematic Literature Review. Physiother Res Int. 2015. p.