I've been tracking my own progress from before to after surgery for chronic back pain. I hurt myself at work, so I'm on Worker's Comp. But I fully intend to get back on the job, so I don't want to be labeled as a shirker. But I have noticed something about myself I can't quite figure out. I am better after the surgery but I'm less satisfied because I'm not completely better. Am I just finding excuses not to go back to work? I don't want to believe that about myself but maybe that's why I feel worse than I am. This seems like such a muddle.

It's not uncommon for patients to experience a change in perception(s) following treatment for a chronic problem like low back pain. It's good you recognize that you really got better as a result of the surgery. But you may be experiencing a shift in the meaning or impact pain has had on daily activities and function.

The change in health status wasn't what you were expecting. You were hoping for a complete cure but what you got was a partial cure. This type of treatment response can shift how you view the results you did get. Social scientists call this the response shift phenomena. The response shift occurs in all kinds of patients whether the health condition is multiple sclerosis, diabetes, dental disorders, joint replacements, cancer, or back pain.

Efforts are underway to look at different types of patients and compare their response shifts. For example, Worker's Compensation patients may have a very different response shift compared with non-Worker's Comp patients. It's possible that patients like yourself who have a partial cure are more likely to develop a response shift.

Knowing there is such a thing as the response shift phenomena may help you understand your own situation. You are asking good questions that will help guide you through the recovery process. A successful return-to-work plan should take into account both your reality and your perception of reality. Vocational counseling may help you sort through all the ifs, ands, and buts you might put up subconsciously as you move toward a full return-to-work status.

Carolyn E. Schwartz, ScD, and Joel A. Finkelstein, MD, FRCS(C). Understanding Inconsistencies in Patient-Reported Outcomes After Spine Treatment: Response Shift Phenomena. In The Spine Journal. December 2009. Vol. 9. No. 12. Pp. 1039-1045.

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