Mark McFarland, DO
Imagine this scenario: You have had significant, unrelenting back pain for months. You’ve seen several doctors and had x-rays and an MRI. You were diagnosed with a major spine issue, such as spinal stenosis or a herniated disc. You’ve tried various conservative treatments, like physical therapy, oral medications and epidural steroid injections, to no avail.
After much consideration, family discussion and consultations with your spine surgeon, you finally make the decision to have spine surgery to fix the problem causing your pain, once and for all. The surgery goes very well with no complications. You are discharged and go home, full of hope for a speedy recovery. You’re feeling pretty good and all of a sudden, you experience severe, crushing depression that seemingly comes out of left field. What is going on?
As a busy spine surgeon, I frequently treat patients who are depressed. Let’s face it…there is nothing fun or enjoyable about being in pain, no matter who you are. When you are hurting, you just want the pain to go away. You tend to avoid activities you enjoy, including exercise, which may exacerbate your pain. Maybe you have had to take time off work, so you don’t feel like you have a sense of purpose every day. As a result, you become disconnected from your friends, your church, your social group, your family and your community. Because you don’t feel well, you may overindulge in things that temporarily make you feel better, such as medications or “other” substances, alcohol, cigarettes or food. Even some of these factors can contribute to or cause depression, even in the most normally positive person.
Making the decision to have spine surgery is a monumental event for anyone. It will impact your family, your career and your future. Many of us go into surgery with very high expectations of the outcome, the speed of recovery and how great we will feel afterwards. We look forward to dancing, carrying our grandkids, walking on the beach or participating in sports. We envision ourselves doing everything we want to do AFTER surgery and we anticipate doing so quickly, with minimal pain and few challenges to overcome.
Spine surgery is light-years ahead of where it was even five years ago. Technology has advanced, minimally-invasive surgical techniques are used and most surgeries are done on an outpatient basis, allowing the patient to return home the same day to recover. Nursing and Physical Therapists are sent to the house to help patients with their recovery and rehabilitation. Many patients return to work in just a few weeks, their pain greatly decreased, if not eliminated altogether. So, why the depression?
No matter how advanced, ALL surgery is taxing to the body, emotionally and physically. Spine surgery is no exception and there are many reasons you can feel down after surgery. All of the following are known to cause or contribute to post-surgical depression:
- Anesthesia drugs used at the hospital
- Post-surgical narcotic pain medications
- Post-surgical muscle relaxant medications
- Pain from your incision and the surgery itself
- Lack of normal movement and activity while recovering
Patients may experience depression before spine surgery, after surgery or both. Many people are surprised at the toll surgery takes on their body and do not realize the length of time it takes to feel “normal” after undergoing a major procedure. As your physician, I want to know if you have issues with depression, no matter when it occurs during your treatment or if you have had it previously, before seeing me.
Working together, we can figure out the best way to treat your depression. You may need a referral to talk to a counselor about your feelings and pain. OSC has a skilled and caring Medical Psychologist, Dr. Cal Robinson, who specializes in working with people who have chronic pain and depression. Even just three or four visits can give you the tools you need to cope more effectively with your pain until you recover.
You may need an anti-depressant medication temporarily, while you are on the mend. Some medications, such as Cymbalta, help with depression AND pain. Returning to work, even part-time or modified duty can help get you out of the house and back into the world, giving you a sense of duty and purpose. I may send you to Physical Therapy or release you to light exercise, because we know that physical exertion is a wonderful natural anti-depressant.
Finally, talk to me or my PA, Erin, about it. There is no reason to be embarrassed or concerned about what anyone will think. Depression after spine surgery is a common and treatable condition. I will help you find the treatment that will work for you so that you can get back to living the life you want.