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Johns Hopkins Pediatric

Improving Neurosurgical Outcomes Through Mental Health



By involving a rehabilitation psychologist and an expert on decreasing opioid use in patient care, the spine team aims to bolster the patient experience before and after surgery.

The patient — a young woman in her thirties — absolutely needed spine surgery. But the path forward was heavily clouded by anxiety. She worried incessantly that her post-surgery pain would be worse than the severe pain she’d been living with for years, or that the surgery itself would lead to life-altering functional limitations.

But after a few sessions with Johns Hopkins rehabilitation psychologist Katie Wright, this patient developed tools — including mindfulness, progressive muscle relaxation, and guided imagery — to take control of her mental health surrounding this procedure.

“She told me how much better she felt having a greater sense of control now that she could self-manage her pain and anxiety,” Wright says.

Johns Hopkins Neurosurgical Spine Center Director Nicholas Theodore reached out to Wright, asking her to become a key part of the multidisciplinary team that cares for spine surgery patients. Research shows that mental health and related issues — such as anxiety, depression, addiction to substances such as tobacco products and opioids, eating disorders, and even unrealistic expectations — can significantly affect surgical outcomes.


“By treating them as unique individuals, and not just their spine problems, we’re having a tremendous impact on patients’ lives.”

“Sometimes we surgeons can get lost in looking at MRIs or planning operations. But when you meet patients, they are always more complicated than their diagnostic imagery,” Theodore says. “Part of making sure patients do well during surgery and afterward is taking care of the whole patient, including their mental health.”

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He and his colleagues refer patients to Wright based on a screening tool that scores them as low, medium, or high risk for mental health issues that could interfere with recovery after spine surgery. Patients with medium or high risk often spend one or more sessions with Wright to identify predictors of poor surgical outcomes, such as pain catastrophizing, kinesiophobia, and distrust of medical providers. Wright works with these patients to overcome these hurdles, sometimes referring them to colleagues in physical therapy, psychiatry and elsewhere for additional help.

Opioid addiction is a frequent problem among spine surgery candidates, Wright adds, especially those who have been in chronic pain for years before their surgeries. Because of this, the care team includes anesthesiologist Marie Hanna, an expert on pain management. She works with patients to develop detailed plans to cut down or completely eliminate opioid use before surgery, which makes these drugs more effective while they recover from procedures.

“By helping patients onto a non-opioid pain intervention, which might include anti-inflammatory drugs, antidepressants, physical therapy and psychology, we can greatly decrease their need for opioid medication after surgery,” Hanna says.

Together, Theodore says, this team approach is improving patients’ lives before, during and after spine procedures.

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