Back surgery is a big thing, and it’s best to prepare both physically (pre-surgery physiotherapy helps a lot especially if you’ve not been moving around much due to pain and responsibilities) as well as psychologically.

Eventhough psychological preparation for back surgery can be very comprehensive, not all patients will need the whole thing – preparing can (and should) be customzied to the different needs of the patient.

Some patients are pretty gritty, so they may not need so much, they can self-guide. Some patients need more so the health care professional and surgeon need to cater to their individual needs and expectations.

Gathering accurate information about back surgery

The amount and quality of information a back surgery patient should gather about the back surgery for optimal results is a function of his/her personality style as well as understanding of medical information.

Like for example, me and my wife are a little different when it comes to handling issues because I’m much more macro and she’s much more micro. It’s not good or bad, it’s just different – I just want to know the topline and she wants to know details.

Generally, the more you can understand the processes, procedures and risk-benefits, the better you will do post-operatively, simply because you know what to expect. It’s aways easier mentally when you already know what’s coming, it’s not surprising.

There are two general types of people when it comes to preparing for surgery:

1. Monitors are information-seekers. These type of people thrive with more information. Herein, the more information you are given about the back surgery, the better you will do. If you are not given enough information, then you tend to show increased anxiety due to not feeling in control and what to expect. My wife’s this type.
2. Blunters are information-avoiders. In the face of the stress or change, you may actually do worse if you are given an overwhelming amount of information about the back surgery. For blunters, a great deal of information results in more pre-operative anxiety and can correlate with worse outcomes. Thus, some level of denial and distraction may work best for blunters. I’m this type, sort of, but it’s not that it’s anxiety provoking to me to get too much info, it’s just that it’s not helpful. I’m a just-in-time learner.

Personality, expectation and (dis)satisfaction

Depending on the above monitors and blunters, you can feel dissatisfied if you weren’t prepared the way you prefer, leading to negative impact or experiences on outcomes.

Funnily enough, eventhough we say that, patients overall tend to have a relatively poor understanding of the medical information presented to them and remember little of what they are told.

The reasons being:

• Surgical consent forms tends to be written like medical papers and scientific journals…which is usually beyond the comprehension of most people. So it’s not surprising that up to 50% or more people read and understand the terms properly
• Secondly, patients may be in pain or overwhelmed with notion of need for surgery. That’s probably why patients can remember less than 50% of the verbal info given to them about their surgery

That’s why we recommend taking down notes, getting your doc to email you information, or going to the doctor with someone you trust when preparing for back surgery.

Psychological preparation for back surgery is pretty important

What are the stresses of back surgery

Not just back surgery, any forms of surgeries can be stressful.

1. Back surgery process

After a back surgery, physical and psychological processes occur that can cause problems which impede healing and recovery, such as:

• Infection
• 2nd damage of cells and tissues due to surgery itself
• Poor immunity
• Physical stress / strain

This can cause you to secrete stress hormones, delayed tissue healing, increased muscle tension, difficulty sleeping, increased heart rate, difficulty breathing and others.

2. Pain after back surgery

Pain is stressful and like I shared earlier, it can be all-consuming if the pain is severe and doesnt go away. Inadequate pain control after spinal surgery can be depressing and very tiresome.

That’s why patients who are provided with adequate pain management tends to become active sooner than those who arent, and they will be more motivated, positive and have less emotional distress when recovering from back pain.

Research show that less than 50% of all surgical patients are provided with adequate pain control following surgery. The government mandated national guidelines for the management of surgical pain in 1992 (through the Agency for Health Care Policy and Research {AHCPR}). The guidelines reviewed an abundance of research showing that poorly controlled pain impairs healing and recovery.

Benefits of psychological preparation for back surgery

Key challenges of preparing for back surgery

1. Tends to be overlooked, especially when the surgeons and medical centers are overwhelmed
2. Patient are overwhelmed and forget, especially when the pain and inconveniences was more than they anticipated. Especially is recovery is slower-than-expected
3. Lack of support by family and workspaces eg if patient lives alone or no caregiver

Mental techniques to prepare for back surgery

You can do a few mental exercises that can help reinforce or change the way you think about a specific upcoming situation to feel more in control, contributing to more positive emotional and mental state.

This can help you with:

1. decreasing anxiety and fear
2. provide you mental preparation to decrease post operative anxieties and pains

• Catastrophizing – imagining the worst possible scenario and then acting as if that will actually happen e.g. asking and thinking “What if I never get better?
• Selective Negative Filtering – focusing only on the negative aspects of a situation to the exclusion of any positive elements or options e.g. This is it, nothing can help me
• Black and white thinking where one can be stuck in a perfectionistic one-sided all-or-nothing point of view without the ability to consider middle grounds. Some patients may think that the surgery is either a complete success or a complete failure
• Overgeneralization is mix of catastrophization and selective negative filtering, and inappropriate filtering eg with this surgery, I can never have any fun again
• Shoulds are one of the most disempowering words and they’re usually paired with the other painful coulds and woulds. Shoulds thinking operates from a list of inflexible and unrealistic rules about how you (your body) and others “should” act or respond e.g. I should never have allowed this to happen

Empowering patients to develop coping thoughts

Especially to manage automatic negative thoughts. We use a Stop-Challenge-Reframe approach which is

1. Quickly identify the negative automatic thoughts when they occur
2. Challenge them through a self-questioning process
3. Replace them with coping thoughts

It’s especially powerful when you use a written journey (or a blog). By practicing daily or as frequently as you can, negative automatic thoughts can be quickly identified and dealt with. This solidifies coping thoughts and frameworks too.

Some examples of positive coping thoughts include:

• I am choosing to have this back surgery for ____
• I can do this for that situation in this ways ___
• I can manage the pain and discomfort which is short term, by doing ___
• I am improving every day with the pain relief physiotherapy techniques

Spirituality and back surgery

Unfortunately many doctors and the medical system tends to ignore or even downplay religion for the patients. In fact, I was told when I first started work as a junior hand therapist that I cannot discuss religious or spiritual matters with patients.

Funnily, it was actually taught in school, and the answer is really straightfoward: a belief in higher power does provide positive contribution to a person’s mental, emotional and physical well being, and can also help with health and surgery outcomes as it can

1. give patients a higher sense of purpose and meaning
2. help them set specific health priorities and goals
3. provides comfort to deal with setbacks and pains

Studies are finally catching up to this. And though I’m no priest or pastor, and even I’m a Christian, most of the time, patients do not need us to pray with them or speak to them about theological understandings – mostly, we just need to encourage them to pray, pray with the elders in their religious setting etc.

It can also naturally link to pain management techniques such as when experiencing pain, they can pray and then practice pain relief techniques such as deep breathing exercises and rationalizing.

It will also help provide hope and focus and purpose to recover faster.

Assertiveness skills to prepare for back surgery

Preparation for that meeting with the surgeon

I recommend patients prepare a list of questions you need answers to, and ask one by one and make sure that you understand all the the doctor say.

Do not feel pressured to skim or skip, because any operations (including spinal surgeries), have risks and benefits. Your role as a patient is to understand them.

You can also bring a trusted family or friend along.

Do not be afraid to go for 2nd or 3rd (or more) opinion, to understand and select a surgeon who you’re comfortable with and is experienced.

Expect pain and learn how to actively deal with pain adequately after back surgery

Adequate and effective pain control after back surgery is crucial, because there is a difference of night and day in terms of mobility, function and confidence of severe pain versus low or no pain.

Firstly, pain is to be expected. In fact, it may be more than the usual pain in the first couple of days, and then it will improve consistently with time, movement and physiotherapy.

You must develop a pain control strategy with your physiotherapy and surgeon such as

1. painkillers in the morning or before much activities
2. moving within pain range but also to push within tolerance
3. which pains to ignore and which pains to pay attention to

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