Anxiety and depression in spine surgery-a systematic integrative review.

BACKGROUND: Symptoms of preoperative anxiety and depression occur in approximately one-third of patients with chronic back pain undergoing surgery. In the last 2 decades, several studies have established that preoperative anxiety and depression are important outcome predictors of greater pain and physical impairments, and lower health-related quality of life in patients undergoing spine surgery. To accommodate symptoms of anxiety and depression and thereby better surgical outcomes, we need to identify factors associated with these symptoms. PURPOSE: We aimed to identify factors associated with symptoms of anxiety and depression in adults both before and after undergoing spinal surgery. STUDY DESIGN: An integrative literature review was carried out. METHODS: The independent charity Helsefonden supported this literature review by contributing $45,000 to remunerate a dedicated investigator. A systematic literature search was conducted in PubMed, CINAHL, PsycINFO, Embase, Scopus, Cochrane, and Web of Science. A three-step selection and assessment process was conducted; titles and abstracts of 1,124 articles were skimmed for relevance and of these, 53 articles were found to be of relevance and were read in full. Articles not meeting the inclusion criteria (n=26) were excluded. The 31 articles were critically appraised for methodological validity; 14 of these were synthesized and analyzed using a convergent qualitative design to transform both qualitative and quantitative articles into qualitative findings. RESULTS: Fourteen studies were included, reporting results based on 4,833 participants, 3,017 men and 1,816 women, whose mean age was approximately 49 years. From these results, we extracted 75 individual findings, which we then divided into five categories of factors associated with anxiety and depression both before and after undergoing spine surgery: pain, information, disability, employment, and mental health. CONCLUSIONS: Five categories of interacting factors that influenced symptoms of anxiety and depression both before and after surgery were identified: pain, lack of information, disability, return to work, and mental health. Information appears to have a regulating effect on anxiety and depression.

Spinal fusion surgery: From relief to insecurity.

BACKGROUND: During their decision-making process patients perceive surgery as a voluntary yet necessary choice. Surgery initiates hope for a life with less pain but also creates a feeling of existential insecurity in terms of fear, isolation and uncertainty. AIM: The aim of this study was to explore how patients experience their situation from the point of making the decision to undergo spinal fusion surgery to living their everyday life after surgery. METHOD: A phenomenological-hermeneutic study design was applied based on the French philosopher Paul Ricoeur's theory of interpretation. Data were collected through observations and semi-structured interviews. FINDINGS: The recommendation and decision to undergo spinal fusion surgery felt like a turning point for the patients and brought hope of regaining their normal lives, of being a more resourceful parent, partner, friend and colleague with no or less pain. Thus, deciding to undergo surgery created a brief feeling of relief. However, life with back pain had changed the patients' understanding of themselves. Consequently, some patients postoperatively experienced insecurity and a weakened self-image with difficulties creating meaning in their lives. CONCLUSION: Being recommended and undergoing spinal fusion surgery initiates hope for a life with less pain and altered life conditions. At the same time, paradoxically, this creates a feeling of existential insecurity in terms of facing the surgery and the future to come. It is, therefore, important to recognise and include the patients' everyday life experiences concerning how they give (or may not give) meaning to their illness, i.e. their understanding of how it is affecting them. These aspects are essential for the patients' definition and re-definition of themselves and thus crucial to draw upon in the relationship and communication between patient and healthcare professional.

Back pain - a feeling of being mistrusted and lack of recognition: a qualitative study.

BACKGROUND: Research shows that suffering from back pain can be associated with great personal costs and that patients undergoing spinal fusion surgery experience particularly problematic illness trajectories and struggle with existential challenges related to living with pain for many years. AIM: This study aims to explore how patients with back pain experience their illness trajectories and their interaction with the healthcare system. METHOD: Data were collected through observations and semi-structured interviews. Data analysis was based on the French philosopher Paul Ricoeur's phenomenological hermeneutic theory of interpretation. FINDINGS: Before the spinal fusion surgery, back pain had a great negative influence on the patients' everyday lives. Insinuations of being a hypochondriac and having to hide their pain to avoid becoming a burden caused insecurity. Several patients experienced pain relieving effect when talking about their experiences. However, they felt that the healthcare professionals were pressed for time and were mainly interested in their physiological problems. Patients were left with a feeling of being mistrusted, powerlessness, insecurity and loss of identity. CONCLUSION: Lifeworld-experiences are not given priority when dealing with patients suffering from back pain. To accommodate individual needs, aspects related to the patients' experiences of their illness trajectories should be taken into account regarding patient communication.