Your Mindset Before Neck Surgery Might Predict Your Success—Here's What Research Shows

If you're considering minimally invasive surgery for a herniated cervical disc, your psychological outlook before the procedure may be just as important as the surgery itself. A recent prospective study of 118 patients found that those with higher levels of pain catastrophizing—a tendency to expect the worst from pain—had significantly lower satisfaction rates after surgery, even when the procedure technically succeeded.

What Is Pain Catastrophizing and Why Does It Matter Before Surgery?

Pain catastrophizing is a psychological pattern where people magnify pain sensations, feel helpless about managing them, and expect negative outcomes. Researchers measured this using the Pain Catastrophizing Scale (PCS), a validated assessment tool that scores how much patients ruminate about pain, feel unable to control it, and worry about its consequences.

In the study, patients were divided into two groups based on their preoperative PCS scores. Those scoring 30 or higher were classified as having high catastrophizing, while those below 30 had low catastrophizing. The difference in outcomes was striking: at six months after surgery, 91.9% of low-catastrophizing patients reported satisfaction with their results, compared to just 46.9% of high-catastrophizing patients.

How Did Surgery Outcomes Differ Between the Two Groups?

Both groups experienced meaningful pain relief and improved function after their minimally invasive cervical disc procedures. However, the high-catastrophizing group showed significantly higher levels of residual neck pain, arm pain, and functional disability at the six-month mark compared to the low-catastrophizing group.

Researchers used multivariable logistic regression analysis—a statistical method that isolates the independent effect of each factor—to determine what predicted dissatisfaction. The findings revealed several key predictors:

• Preoperative Pain Catastrophizing Score: A score of 30 or higher was identified as a strong independent predictor of patient dissatisfaction, with patients in this group being 4.5 times more likely to be dissatisfied with their surgical outcomes.
• Symptom Duration: Patients who had experienced symptoms for longer periods before surgery were also more likely to report dissatisfaction, suggesting that chronic pain patterns may be harder to reverse even with successful intervention.
• Psychological State: The study underscores that pain is not purely physical; how your mind processes and anticipates pain significantly influences your recovery experience and satisfaction.

What Should Patients Do With This Information?

The research team emphasized that pain catastrophizing is a modifiable risk factor, meaning it can be improved through targeted interventions. Rather than accepting a pessimistic mindset as unchangeable, patients can work with mental health professionals, physical therapists, or pain psychologists to reframe their relationship with pain before undergoing surgery.

The study included 118 patients who completed a six-month follow-up after undergoing CT-guided percutaneous ozone chemoneurolysis, a minimally invasive procedure for single-level cervical disc herniation. All participants completed standardized assessments measuring neck and arm pain using a visual analog scale, functional disability using the Neck Disability Index (NDI), and satisfaction using the North American Spine Society (NASS) Patient Satisfaction Index.

Based on these findings, researchers recommend that preoperative screening should routinely include psychosocial assessment using the Pain Catastrophizing Scale, along with evaluation of how long symptoms have persisted. This allows surgeons and care teams to identify high-risk patients early and implement targeted interventions—such as cognitive behavioral therapy, mindfulness training, or pain education—before surgery to optimize outcomes.

The takeaway is clear: if you're considering cervical spine surgery, addressing your psychological relationship with pain beforehand may be just as valuable as the surgical technique itself. Managing expectations and shifting catastrophic thinking patterns could be the difference between viewing your surgery as a success or a disappointment.