If you think you’re going to have a bad result does it mean it will happen? My wife is going to have disc surgery and already thinks it won’t help. Can pessimists have a good result?

Scientists are busy trying to figure out just who are the best and worst candidates for back surgery. Identifying risk factors before the operation might make a difference. Reducing, modifying, or eliminating risk factors may reduce disability later on.

In general, research shows that pessimists who expect the worst have worse health outcomes. Having a negative attitude is linked with greater pain and more disability after surgery. Specific studies of patients who have a disc taken out because of lumbosacral radicular syndrome (LRS) show a trend toward greater disability when cognitive-behavioral factors are present.

There are three parts to cognitive behavioral factors: 1) fear of movement or reinjury, 2) passive pain coping, and 3) negative outcome attitude. Passive pain coping refers to retreating from activity and movement by sitting, lying, or resting for long periods each day. Having a negative view of the outcome is also linked with disability six weeks and six months after the surgery.

People who think that the surgery might not help are more likely to be disabled six weeks after the operation. The same is true after six months. Studies are now needed to show if changing the thoughts and behavior of LRS patients might reduce disability later.