Study Overview and Context
A 2026 study published in *Cureus* investigated the psychological factors influencing treatment decisions for patients with spine disorders, focusing on tomophobia (fear of surgery) and tomophilia (positive inclination toward surgery). The research, conducted by a team of clinicians and researchers, aimed to clarify how these psychological constructs interact with clinical assessments in shaping patient preferences. The study was registered in the Clinical Trials Registry-India (CTRI No.: SSHRI/CS/NS/Tphobia-philia/BRD/88/12.25) and involved 200 adult patients with cervical, thoracic, or lumbar spine disorders. Both surgical and non-surgical management options were deemed clinically appropriate for participants, allowing the researchers to examine how psychological traits might affect decision-making. The study highlights the growing recognition of psychological factors in clinical outcomes, particularly in spine care, where treatment choices often involve complex trade-offs between risks and benefits.
Methodology and Patient Demographics
The prospective observational study included 200 patients with degenerative spine conditions, such as lumbar spinal stenosis, mechanical low back pain, and spondylolisthesis. The cohort had a mean age of 56.96 years, with 55% female participants and 45% male participants. Educational backgrounds varied, with 67% having undergraduate education and 25% being graduates. Occupational categories included housewives (54.5%), retired individuals (19%), and others. Clinical assessments included visual analog scale (VAS) for pain, Oswestry Disability Index (ODI), and Neck Disability Index (NDI) to measure disability. Psychological evaluations used the Generalized Anxiety Disorder 7-item Scale (GAD-7) and Pain Catastrophizing Scale (PCS) to gauge anxiety and catastrophic thinking. Patients were categorized into tomophobic (n=62, 31.0%) or tomophilic (n=138, 69.0%) groups based on their responses to a structured questionnaire. The study emphasized the importance of combining clinical and psychological data to improve treatment decision-making.
Psychological Profiles and Treatment Preferences
Of the 200 patients, 69% preferred surgical management, 25.5% chose conservative treatment, and 5.5% remained undecided after counseling. A statistically significant association (p<0.001) was found between psychological disposition and treatment preference. Tomophobic patients predominantly selected conservative options or remained undecided, while tomophilic patients strongly favored surgery. Tomophobia correlated with higher GAD-7 and PCS scores, indicating greater anxiety and catastrophic thinking, but there were no significant differences in VAS or disability indices (ODI/NDI) between groups. This suggests that psychological factors may independently influence treatment choices, even when clinical severity is comparable. The study also noted that tomophilic patients showed a strong preference for surgery regardless of radiological findings, highlighting the role of positive expectations in decision-making. These findings underscore the need to address psychological barriers and biases in clinical practice.
Implications for Clinical Practice
The study emphasizes the critical role of psychological factors in shaping treatment preferences for spine disorders. Clinicians must recognize that patient decisions are not solely based on clinical severity or imaging findings but are also influenced by emotional and cognitive factors. The researchers advocate for integrating structured psychological assessments into routine evaluations to better align treatment plans with patient needs. For chiropractors and other spine care providers, this suggests a need to consider patients' fears and expectations when discussing management options. The study also highlights the value of multi-tier reassessment protocols in resolving diagnostic uncertainties, ensuring that both clinical and psychological data inform decisions. While the study does not propose specific interventions, it calls for further research to validate these psychological constructs and develop strategies to address tomophobia or enhance tomophilic tendencies where appropriate.
Limitations and Future Research
The study acknowledges several limitations, including its observational design, which precludes causal inferences about the relationship between psychological factors and treatment preferences. The sample size, while substantial, may not be representative of all spine disorder populations, particularly those with different cultural or socioeconomic backgrounds. Additionally, the study focused on patients for whom both surgical and non-surgical options were deemed appropriate, limiting generalizability to cases with clear indications for one approach. The authors also note the need for psychometric validation of tomophobia and tomophilia as clinical constructs, as their conceptual overlap with treatment preferences requires further clarification. Future research could explore longitudinal outcomes to determine how psychological factors influence long-term treatment adherence and satisfaction. Larger, multi-center studies may help confirm these findings and refine strategies for integrating psychological assessments into spine care protocols.