Depressive symptoms associated with poor outcome after lumbar spine surgery: Pain and depression impact on each other and aggravate the burden of the sufferer

Harald Breivik

doi:10.1016/j.sjpain.2016.04.006

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Depressive symptoms associated with poor outcome after lumbar spine surgery: Pain and depression impact on each other and aggravate the burden of the sufferer

Harald Breivik

Published/Copyright: July 1, 2016

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From the journal Scandinavian Journal of Pain Volume 12 Issue 1

In this issue of the Scandinavian Journal of Pain Voitto Järvimäki and co-workers publish a study documenting association between depressive symptoms and poor outcome after lumbar spine surgery 1. They found that patients with melancholic depression (11% of all) had more pain and more pain-interference with function, and they used more but had less relief from pain-medication, compared with patients who were not depressed. Patients with non-melancholic depression (almost 30% of all) also had less benefit from spine surgery than non-depressed patients, but slightly better outcomes than those with melancholic depression. They recommend strongly that patients with indications for spine surgery be screened for co-morbid depression and that those with depression have preoperative and postoperative well-tailored rehabilitation programmes 1.

The Järvimäki et al. study is a cross-sectional study, but they focus well on these important and common problems that burden chronic back pain patients: When pain and depression co-occur, they impact on each other and they play important roles in development and maintenance of chronic health problems [2,3].

A number of papers and editorial comments have been published in the Scandinavian Journal of Pain focusing on aspects of these comorbid health problems, attempting to understand the link between depression and pain and how to examine and manage both [2,3,4,5,6,7,8 9]. Depression is a problem in the young adolescent [4,5] as well as in the older adults with persistent pain 6. Depression increases the burden of pain and pain deepens the depressed mood. Unfortunately it is a fact that the risk of suicide attempts is significantly higher in patients with chronic pain than in patients without pain [7,8].

For all these reasons it is important for clinicians to assess both depression and pain as early as possible, using the Beck [1,10] or the HADS-D screening tools 11. Both symptoms should be monitored and addressed in treatment programmes to maximize outcome results. Because pharmacological treatment has limited effects for depression, and analgesic drugs are not much better for chronic pain, psychological approaches and cognitive-behavioural therapy are alternatives [2,9].

Patients with back pain who are candidates for spinal surgery, certainly are no exceptions to the linking of depression and chronic pain: Whereas the surgeon’s tools may correct and sometimes remove a cause of spinal pain, observing and handling the comorbid depression is mandatory for optimal outcome of spinal surgery for pain 1.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2016.01.008

Oslo University Hospital, Department of Pain Management and Research, Pbox 4950 Nydalenm, 0424 Oslo, Norway. Tel.: +47 23073691

Conflict of interest

None declared.

References

[1] Järvimäki V, Kautiainen H, Haanpää M, Koponen H, Spalding M, Alahuta S, Vakkala M. Depressive symptoms are associated with poor outcome for lumbar spine surgery. Scand J Pain 2016;12:13-7.Search in Google Scholar

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[4] Stabell N, Flægstad T, Stubhaug A, Nielsen CS. Associations between abdominal pain symptom dimensions and depression among adolescents. Scand J Pain 2014;5:184-90.Search in Google Scholar

[5] Breivik H. Depression and anxiety in adolescents aggravate abdominal pain, and abdominal pain deepens depression which increases suffering from chronic pain. Scand J Pain 2014;5:182-3.Search in Google Scholar

[6] Wood BM, Nicholas MK, Blyth F, Asghari A, Gibson S. The mediating role of catastrophizing in the relationship between pain intensity and depressed mood in older adults with persistent pain: a longitudinal analysis. Scand J Pain 2016;11:157-62.Search in Google Scholar

[7] Stenager E, Christiansen E, Handberg G, Jensen B. Suicide attempts in chronic pain patients. A register-based study. Scand J Pain 2014;5:4-7.Search in Google Scholar

[8] Breivik H, Endresen Reme S, Linton SJ. High risk of depression and suicide attempt among chronic pain patients: always explore catastrophizing and suicide thoughts when evaluating chronic pain patients. Scand J Pain 2014;5:1-3.Search in Google Scholar

[9] Linton SJ, Fruzzetti AE. A hybrid emotion-focused exposure treatment for chronic pain: a feasibility study. Scand J Pain 2014;5:151-8.Search in Google Scholar

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Published Online: 2016-07-01

Published in Print: 2016-07-01

Articles in the same Issue

https://doi.org/10.1016/j.sjpain.2016.04.006