On the basis of a few questions he asked me, my doctor thinks I should see a counselor to help me deal with my back pain and depression. He thinks the two are linked together and the only way I can lick one is to work on both areas at the same time. I don’t see the connection myself. Is there any way to research this on my own?

In a report offered at the North American Spine Society’s annual conference this year, physicians were reminded not to rely on their own memory by asking favorite questions when interviewing patients to assess the patient’s psychologic state. There are better, more accurate tools available to do this. One of those tools is a psychologic questionnaire called the Distress Risk Assessment Method (DRAM).

According to a recent study, experienced surgeons aren’t any better than less experienced physicians in assessing patients’ psychologic stress. This type of evaluation is important because past research has shown there is a significant impact of a patient’s psychologic health on their response to treatment for spine-related back pain.

To come to this conclusion, eight spine doctors (equal numbers of surgeons and physiatrists) interviewed 50 patients each (for a total of 200 patients in the study). The doctor-patient interview was meant to do a psychologic assessment and determine who needed psychologic help. Each of the 200 patients also filled out the DRAM questionnaire. The results of these two measures were compared.

Categories used to classify patients’ psychologic risk included normal (N), at-risk(AR),distressed depressive (DD), and distressed somatic (DS). It turned out that nonoperative spine specialists (those who offer conservative, nonsurgical care) were much better at recognizing when patients had significant levels of psychologic stress to be at risk for a
poor treatment result.

Surgeons relying on their own instincts were less likely to detect patients who were at-risk or distressed. It was suggested that physicians use the DRAM for better results in this area of assessment. The DRAM has been validated by research studies. This means it is both reliable and effective in measuring psychologic distress in spine patients.

This study mostly shows that when it comes to recognizing the psychologic components of back pain, many patients are underdiagnosed. The fact that your doctor could see the possibility of an underlying psychologic state affecting your overall health suggests he is up to date in this area. It can’t hurt to follow his advice. After consulting with a mental health care specialist, you may feel differently about this issue.