Behavioral Pain Management for Spine Surgery Patients (Podcast)

Perioperative program provides skills to mitigate pain during recovery from surgery

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Between 10% and 40% of patients who undergo lumbar spine surgery experience persistent post-surgical pain, leading to emotional distress, impaired quality of life and increased healthcare costs. Cleveland Clinic’s Center for Spine Health offers all spine surgery patients the chance to participate in a two-hour behavioral pain management class based on the Empowered Relief™ self-management intervention from Stanford University. Cleveland Clinic has integrated Empowered Relief into a perioperative program called TREK for Surgical Success, a promising pathway for spine surgery patients to help mitigate pain.

“Pain is a big problem from a public health standpoint, and its costs exceed those for any other health condition,” says Sara Davin, PsyD, MPH, a psychologist in the Center for Spine Health who specializes in pain and spearheads the class. “It is a passion of mine to target as many people as possible who have pain so that we can reduce the number who end up contending with refractory chronic pain conditions.”

In the most recent episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Davin discusses psychological interventions to improve outcomes for patients undergoing spine surgery. She covers, among other topics:

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  • Psychosocial factors that contribute to challenging post-surgical outcomes
  • The importance of a multidisciplinary approach to preventing persistent post-surgical pain
  • The structure and content of the TREK for Surgical Success program
  • Considerations for launching a standard-of-care behavioral pain management class

Click the podcast player above to listen to the 26-minute episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at or wherever you get your podcasts.

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Excerpt from the podcast

Podcast host Glen Stevens, DO, PhD: We mentioned the high likelihood of persistent pain following lumbar spine surgery. As you said, even if it’s 10%, it’s 10% too much. What factors contribute to these numbers?

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Dr. Davin: It’s complicated. I can speak to what we know from the literature specifically related to psychosocial factors, which are consistent contributors. In particular, depression is one of the most consistent predictors of having a more challenging post-surgical outcome. Along the same lines, significant levels of anxiety or cognitive disturbance can be challenges. Any sort of substance use disorder can also create challenges.

This tells us that there is a lot of opportunity from a psychosocial perspective. And it is totally understandable for folks who have chronic pain to develop some degree of depression. They have a condition that goes on and on, and it interferes with life. Most people would feel frustrated, and if that goes on long enough, they can experience depression. So, just knowing that — and knowing that depression might be one of the biggest predictors — really justifies intervening as soon as possible with folks from a broad, whole-person perspective that incorporates both the mind and the body.