Associations Between Minnesota Multiphasic Personality Inventory‐2‐Restructured Form (MMPI‐2‐RF) Scores, Workers' Compensation Status, and Spine Surgery Outcome

Abstract

This study examines whether workers' compensation (WC) patients respond more poorly to spine surgery than non-WC patients and whether poorer outcome is associated with individual differences in personality and emotional variables, as assessed by the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Three-hundred eighty-two patients underwent presurgical psychological screening that included a diagnostic interview and psychometric testing. Pain level, functional ability, work status, medication use, and emotional distress were assessed at baseline and at an average of 6 months postoperative. WC patients showed significantly poorer response to spine surgery than did non-WC patients on measures of pain level, functional ability, work status, medication use, and emotional distress. MMPI-2-RF scales assessing demoralization, somatic complaints, and low positive emotions were found to be incrementally associated with diminished surgery results.Spine surgery can lead to dramatic improvements in pain and functional ability; however, such sanguine results are far from universal. For example, a recent analysis of discectomy patients found that 28% had unfavorable outcomes (Sherman et al.,

Associations Between Pre-Implant Psychosocial Factors and Spinal Cord Stimulation Outcome

“…MMPI-2-RF scales in this domain that were found to be associated with poorer outcome assess feelings of being overwhelmed, highly distressed, and dissatisfied with life, in addition to an inability to experience positive emotions, higher levels of anxiety and anger, and lack of self-confidence. Higher scores on these scales have also been to be associated with adverse outcomes of spine surgery (Block et al, 2014; Marek, Block, et al, 2015), as well as with higher levels of negative affect and maladaptive eating behaviors at 3 months following bariatric surgery (Marek, Ben-Porath, Merrell, Ashton, & Heinberg, 2014). Patients with these symptoms are likely to have problems with motivation and with recognition of treatment gains, whereas patients who do not experience such issues tend to have better SCS results.…”

“…Participants rated the intensity of emotions they experienced on Likert-type scales ( Not at all to Extremely ), and pain on a 0 to 10 Likert-type scale (higher value indicating more pain). Exploratory factor analyses indicated that the current emotional state items can be aggregated into two scales: Negative Affect and Positive Affect (Block et al, 2014; Marek, Block, et al, 2015). We used the Negative Affect scale in the current investigation because it was marked by items such as depressed mood, worry, anger, and fear.…”

“…A previous study by Block, Ben-Porath, and Marek (2013) established normative values on the MMPI-2-RF for both SCS and spine surgery candidates, finding no clinically significant differences in the mean profiles for these two patient groups. In separate studies, they examined the associations between MMPI-2-RF scale elevations, as well as other psychosocial factors, with spine surgery outcome at 6 months postoperative (Block, Marek, Ben-Porath, & Ohnmeiss, 2014; Marek, Block, & Ben-Porath, 2015). Several outcome measures were used, including reported pain level, the Oswestry Disability Index (ODI; a measure of functional ability; Fairbank, Couper, Davies, & O’Brien, 1980), medication status (whether the patient was using narcotic, nonnarcotic, or no medication), work status, negative affect, as well as an overall outcome measure that combined these measures.…”

Demoralization, Patient Activation, and the Outcome of Spine Surgery

“…[ 13 ]; Block, Marek, Ben-Porath and Ohnmeiss [ 24 ]) has found that elevated scores on the demoralization scale, RCd, are strongly correlated with poorer results at six months post spine surgery, including less improvement in pain and in self-reported physical disability, lower return to work rates, greater use of opioid medication, poorer satisfaction with surgical outcome, and worse overall outcome. Further, specific components of demoralization assessed by the MMPI-2-RF, including scales measuring Helplessness/Hopelessness, Self-Doubt and Inefficacy (a belief that one is incapable of making decisions and coping with difficulties), are significantly associated with poorer satisfaction and reduced results of both spine surgery (Block, Ben-Porath, Marek and Ohnmeiss [ 24 ]) and poorer results of spinal cord stimulation (Block, Marek, Ben-Porath and Kukal [ 12 ]). Further, scale RCd, is the only MMPI-2-RF scale associated with poor results in all the outcome areas assessed.…”

“…Certainly, my own research (see Block [ 10 ]) as well as that of others (Voorhies et al [ 16 ]; denBoer et al [ 43 ]), which has been focused on assessment of psychological “risk” factors, continues to demonstrate how specific psychological characteristics can undo even the most effective surgical intervention. We (Block, Marek, Ben-Porath and Ohnmeiss [ 24 ]) have found that, in addition to demoralization, several other characteristics assessed by the MMPI-2-RF are strongly correlated with reduced spine surgery results, including somatic sensitivity and malaise (Scales RC1 and MLS), low positive emotion (scale RC7), family problems (FML), social avoidance (SAV), and the PSY-5 scale negative emotionality/neuroticism (NEGE-r). However, the complexity of human nature is such that individuals may have strengths—traits, behaviors and emotional states--that can counteract more negative characteristics.…”