Michael D. Daubs, MD
The Spine Journal
Available online 12 December 2013

Abstract
Background Context
Psychological distress has been shown to adversely affect the treatment outcomes of many spinal disorders. Most physicians do not routinely use psychological screening questionnaires. Additionally, physicians have not performed well when assessing patients for psychological distress while using clinical impression alone.

Purpose
The purpose of our study was to evaluate the clinical factors that most accurately predict the presence of psychological distress in patients presenting for the evaluation of a spinal disorder.

Study Design
Retrospective

Patient Sample
388 patients

Outcome Measures
Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Distress Risk Assessment Method (DRAM)

Methods
388 consecutive patients presenting for the evaluation of a spinal disorder with a completed DRAM, ODI, and VAS were evaluated. The DRAM was utilized to classify the patients’ level of psychological distress. Clinical variables such as history of depression, use of anti-depressants, use of other psychotropic medications, history of prior surgery, and history of chronic pain syndromes along with ODI and VAS scores were used to develop a model to predict a patient’s level of psychological distress.

Results
Our model was highly accurate (92%), sensitive (92%) and specific (95%) in predicting a patient’s level of psychological distress. If a patient’s VAS is 4 or 5, and their ODI is less than 45 and they are not on any psychotropic medications they likely will fall into the Normal group. Patients with a VAS greater than 7 and currently taking anti-depressants or other psychotropic medications, or an ODI greater than 58 and a history of prior surgery are likely to fall into the higher distressed categories of Distressed Depressive (DD) or Distressed Somatic (DS).

Conclusions
A patient’s clinical history, ODI, and VAS scores can predict their level of psychological distress. In general, patients with higher VAS pain scores, higher ODI scores (greater than 58), and those taking an anti-depressant or another psychotropic medication, were likely to have high levels of psychological distress. The predictive clinical factors noted in this study are readily available to most physicians treating spinal disorders, and may be helpful in improving their ability to detect patients with psychological distress, counseling them on realistic outcomes, and possibly improve their treatment outcomes.

Journal Reference:  http://www.sciencedirect.com/science/article/pii/S1529943013019827