IntroductionThe purpose of the literature study was to get an overview of what has been published concerning clinical anxiety and depression in patients undergoing surgery for cervical degenerative disc disease.
The purpose of the pilot study was to find the preoperative prevalence of clinical anxiety and depression in a group of patients operated with ACDF for degenerative disc disease, and to compare it with figures from the general population. Furthermore, the purpose was to assess the patients` subjective pain intensity and their methods for coping with pain and explore possible correlations between these factors and the presence or absence of anxiety and/or depression.
MethodFor the literature review a search in PubMed database was done using the searchwords "cervical discectomy and psychology" or " anterior cervical decompression and psychology", "cervical discectomy and clinical depression" or " anterior cervical decompression and clinical depression", "cervical discectomy and anxiety disorder" or " anterior cervical decompression and anxiety disorder", ”cervical radiculopathy and psychology” or “cervical radiculopathy and clinical depression” or cervical radiculopathy and anxiety disorder”. Five relevant articles were identified, read and evaluated.
The pilot study included 30 patients with symptomatic cervical disc disease admitted to department of neurosurgery at Rikshospitalet for planned anterior cervical discectomy and fusion. Pain intensities for radiating pain, neck pain and headache were scored using the visual analogue scale (VAS). The presence of depression and anxiety was determined by the questionnaire Hospital Anxiety and Depression scale (HAD). Pain coping ability was evaluated using Pain Stages Of Change Questionnaire (PSOCQ ). This is the first study, to my knowledge, that uses PSOCQ on such a group of “pain-patients”.
ResultsThe literature study yielded 5 relevant articles. Two studies found a high prevalence of anxiety and depression. They also found that the two conditions correlate with each other, with higher pain intensity, and with longer lasting pain. One study found that good psychological health preoperatively, was the only factor predicting good postoperative outcomes concerning radiating pain, neck pain, physical disability and general health. Another study found that surgery outcome mainly depends upon physical factors. The articles were different concerning goals, methods, results and quality. In spite of that, they all somewhat acknowledged psychological factors as being important for many patients` condition before and after surgery.
The pilot study found the prevalence of clinical anxiety and/or depression to be 43,3%. In general, the patients reported higher levels of radiating pain than neck pain and headache. The ones with anxiety and/or depression reported more intense headache, a little more neck pain, and a little less radiating pain than the others. None of the results from VAS were statistically significant. The patients with anxiety and/or depression got statistically significant higher values than the other patients in the category “contemplation” in PSOCQ. The ones with anxiety and/or depression also got lower values in the category “maintenance”, although this was not statistically significant.
ConclusionTwo articles from the literature study found high prevalence of anxiety and depression in patients, and these two conditions were found to coexist. Some other factors were also found to covariate with the extent of symptoms of depression and anxiety. One study found ratings on psychological surveys to be the best predictor of surgical outcome, while another study concluded that surgery outcome is determined mainly by physical factors. The articles were different concerning purpose, method and results, but to some extent they all acknowledged psychological factors to be important in this group of patients.
The prevalence of anxiety and depression among patients in the pilot study was found to be high compared with numbers of the general population. In general, the patients reported higher intensity of radiating pain than of neck pain and headache. The patients with anxiety and/or depression have more intense headache, more neck pain and less radiating pain than the other patients. The patients with anxiety and/or depression got statistically significant higher values than the others in the category “contemplation” in PSOCQ, indicating a beginning readiness to adopt self-management in pain coping amongst these patients.