Predicting Back Pain Treatment Outcomes Among Workers’ Compensation Patients: Important Information for Clinical Neuropsychologists

Abstract

Low back pain is an increasingly prevalent and costly issue in the United States. It is a particularly relevant problem for Workers' Compensation patients, who typically experience worse surgical and functional outcomes than their non-compensated counterparts. Neuropsychologists often provide intervention and assessment services to compensated patients with back pain, and thus it is critical they possess a basic understanding of the factors that might predispose an injured worker to poor spine surgery outcomes. This paper will review the current literature regarding presurgical biopsychosocial factors which have been implicated in poor back surgery outcomes among injured workers. We provide some tentative guidelines for neuropsychologists to utilize in providing services to injured workers with back pain.

Clinical Depression Is a Strong Predictor of Poor Lumbar Fusion Outcomes Among Workersʼ Compensation Subjects

“…[1][2][3][4][5][6][7] Because relatively few studies exist examining risk factors for poor lumbar fusion outcomes among the WC population, 4-5 , 8 , 12 we wanted to examine how psychosocial factors, chiefl y depression, impact lumbar fusion outcomes in a WC setting. WC patients tend to have worse lumbar fusion outcomes and lower postoperative RTW rates.…”

“…[1][2][3][4][5][6][7] A 2010 case-control study reported that WC subjects, when compared with the general population, had signifi cantly less improvement in mean Oswestry Disability Index and 36-Item Short Form Health Survey scores after fusion. [1][2][3][4][5][6][7] A 2010 case-control study reported that WC subjects, when compared with the general population, had signifi cantly less improvement in mean Oswestry Disability Index and 36-Item Short Form Health Survey scores after fusion.…”

Psychological Predictors of Outcomes with Lumbar Spinal Fusion: A Systematic Literature Review

“…A recent summary of the CPGs and payer policies for LSF suggests that the spine care community needs to develop (or update) guidelines for candidacy using a biopsychosocial perspective, which should be collaborative across specialty/society groups. A biopsychosocial perspective is commonly used to evaluate a patient's risk of poor recovery from either conservative or surgical care for LBP (Wheeler et al, ).…”

Older Age and Leg Pain Are Good Predictors of Pain and Disability Outcomes in 2710 Patients who Receive Lumbar Fusion

“…First, the clinical tests and measures associated with fusion do not predict who is likely to benefit [38]. Second, it is well known that non-physical, non-pathoanatomical variables (e.g., depression) can independently influence outcomes after LSF [37]. Third, there is a notable lack of uniformity across clinical practice guidelines with respect to suggesting appropriate candidates for LSF [6,30].…”