Psychological evaluation of the spine patient.

The biopsychosocial perspective focuses on the interaction among biologic, psychological, and medicolegal variables of patients coping with a persistent medical condition. It is considered the most comprehensive and heuristic approach to psychological evaluation in the spine patient. Assessment proceeds in three steps, from global indices of emotional distress to evaluation of more specific diagnoses of psychopathology. Step 1, the initial screening, uses psychometrically sound instruments to determine the level of patient distress. Step 2, the psychosocial interview, indicates whether additional psychological testing is needed. Step 3, the presurgical evaluation, assesses patients being considered for a surgical procedure. This stepwise assessment approach significantly aids in yielding evidence-based outcomes as well as in identifying the patient who may be most recalcitrant to treatment intervention.