Psychological Assessment and Behavioral Management of Spine Pain

Abstract

Current data supporting the psychological assessment and treatment of acute and chronic spine pain are reviewed, with specific attention to the practical management of patients with complex pain disorders. Strategies for assessing risk factors are addressed, including common psychiatric comorbidities of anxiety, depression, disability, and substance use disorders. Brief assessment instruments are described with specific attention to their utility in clinical practice. Screening and management of special conditions are addressed, including patients presenting for neurostimulation and spinal fusion. An overview of commonly used behavioral treatments is provided, including cognitive therapy, acceptance and commitment therapy, mindfulness meditation, and operant pain rehabilitation approaches. Strategies for addressing fear-avoidance, catastrophizing, and somatic concern are reviewed. Considerations for special populations are discussed including patients presenting with the use of chronic opioids, marked somatization, and work-related injuries. Conclusions underscore the benefits of applying a biopsychosocial model of assessment and treatment of pain conditions and the importance of reducing barriers to psychological care.