gms | German Medical Science

Objective: Many patients with CLBP have somatoform disorders as well as accompanying anxiety disorders or depression. In many spine clinics no screening regarding these accompanying disorders is yet performed.This study was performed to evaluate whether the Hospital Anxiety and Depression Scale (HADS) brief test, which takes only 4-5 minutes to fill in and 30 seconds to assess, is able to detect within a minimum of time patients with the above concurrent diagnoses.

Methods: 88 patients with CLBP and sciatica were enrolled in this study, 3 were lost to follow-up. All completed the HADS questionnaire prior to examination. Indications for minimally-invasive pain therapy interventions were made by an experienced spine surgeon based on history, examination and MRI-results, but blinded to the result of the HADS. Before treatment as well as 6 weeks, 3 and 6 months after the procedure, visual analogue scale (VAS) back pain, Oswestry Disability Index (ODI) were recorded. The minimally-invasive spine procedures performed were: 51 radiofrequency rhizotomies of lumbar facets, 22 epidural neuroplasties and 12 intradiscal decompressions.

Results: At 6 months, VAS in all patients improved by 2.2±0.96 while ODI decreased by 10±4.67 (± SEM). However, in the subgroup with a high-risk of somatoform disorder (HADS > 18; n=30) VAS and ODI improvements were only 0.9 ±0.68 and 7±4.3, respectively, whereas in the low-risk subgroup (HADS < 12; n=34) VAS and ODI were significantly reduced: 2.5 ±0.7 and 13.5±3.3, respectively. The intermediate group with HADS score >12 < 18 (n=21) displayed a VAS improvement by 2.2±0.94 and a decrease in ODI by 10±2.9 (± SEM). Furthermore, there was a significant difference in the improvement measured by VAS (p < 0.003) as well as by ODI (p < 0.05) between the high- and low-risk HADS groups.

Conclusion: In a selected group of patients with CLBP and sciatica, the easy-to-administer HADS appears to reliably predict the outcome of minimally-invasive pain procedures, most probably due to the detection of somatoform comorbidities such as anxiety disorders or depression. It is well accepted, that invasive therapies in such patients frequently are unsuccessful. Most alarming is the probable fact that in our study 30 patients were invasively treated without effect. This has impact not only because of unnecessary and potentially harmful procedures being performed but also because of increasingly limited healthcare funds.