Preoperative Evaluation of Psychosocial Aspects and Work-Related Issues

Physical pain may be only one component of disability, with the main contributor being the psychological reaction to pain. Our understanding of chronic pain has shifted because of the move away from the disease model of illness to the biopsychosocial model. The biopsychosocial model, introduced by George Engel, provides “a way of understanding the patient’s subjective experience as an essential contributor to accurate diagnosis, health outcomes, and humane care”; whereas the disease model simply assumes the pain arises solely from physical pathology.

The Global Spine Care Initiative, which proposes an evidence-based model of care that seeks to transform spine care globally, has included the biopsychosocial model as one of its eight core principles. It is important to recognize that patients’ spinal health is influenced by a variety of factors and their complex interactions. Not only biological factors, but psychological and social ones as well, contribute to a patient’s pain, disability, and disease. Addressing all of these factors often requires a multidisciplinary team, but ensures the patient is treated as a whole person and receives comprehensive care. When surgeons fail to address the underlying stress, distress, and ineffective coping strategies that are contributing to a patient’s somatic complaints, there is a failure of care, better known as the “failed back” in the field of spinal surgery.

A thoughtful preoperative evaluation is crucial to the identification of the various psychosocial and workplace factors that may influence the patient’s clinical presentation and ability to recover from surgery. Awareness of how these factors influence patient outcomes is paramount to the selection of surgical candidates to ensure the best outcomes, with relief of symptoms and return to work.