A review of psychological considerations in the neurosurgical management of chronic pain: A neurosurgeon’s perspective

Psychological considerations in the complaint of chronic pain are increasingly recognized to be important. A review of 1,541 consecutive patients evaluated in a multidisciplinary pain treatment group and a subset of 1,032 of these patients with pain of spinal origin were reviewed with regard to psychiatric, psychological, and psychosocial factors. Of these patients, 258 were found to have normal premorbid psychological profiles and an acceptable diagnosable physical cause for the complaint of pain. In 52 patients, no psychological or physical problems could be identified to explain the abnormality. In 103 patients a definitive psychiatric diagnosis was made. In 619 patients, a diagnosis of personality disorder or personality dysfunction was made. An unusually prolonged adjustment disorder was identified in 304 patients, and 203 were thought to have a long-standing dysfunction present before the disabling pain-producing event. Of this group, 112 were diagnosed as true personality disorder. Reactive depression was present in 908 patients and 825 exhibited chronic anxiety state. When first seen, 928 patients were using narcotics and 825 were using a psychotropic drug. Only 10% were taking no drugs. The presence of a psychiatric diagnosis or personality dysfunction correlated with poor outcome from interventional procedures. Depression, anxiety, and previous drug use did not relate to outcome.