Spinoxiety: Anxiety-Driven Symptom Amplification and Communication Needs in Patients with Spine-Related Pain

Anxiety, catastrophic interpretation, and fear-based illness beliefs can amplify pain and disability in patients with spine-related symptoms, particularly when imaging findings, online information, or previous medical opinions are interpreted as evidence of serious damage. We proposed Spinoxiety as a non-diagnostic clinical communication framework describing anxiety-driven amplification of spine-related symptoms. We evaluated its potential clinical utility in adults presenting with neck and/or back pain.

In this prospective observational study, 200 adults with spine-related pain were categorized as Type 1 Spinoxiety (predominantly self-amplified anxiety through internet-based interpretation, self-diagnosis, cognitive hypervigilance, and catastrophic thinking) or Type 2 Spinoxiety (predominantly externally reinforced anxiety arising from doctors, relatives, friends, or social sources). Anxiety (generalized anxiety disorder-7), pain catastrophizing (PCS), pain intensity (Visual Analog Scale), and functional disability (Oswestry disability index/neck disability index) were assessed at baseline and after 6 weeks of routine clinical care and communication.

All clinical and psychological outcomes improved significantly at 6 weeks. However, patients with Type 1 Spinoxiety demonstrated significantly higher residual anxiety and PCS than those with Type 2 Spinoxiety, despite broadly comparable improvements in pain intensity and functional disability. Type 2 patients exhibited greater psychological recovery during follow-up.

Spinoxiety may provide a practical clinical communication framework for identifying the dominant source of fear, tailoring patient and family communication, and improving expectation-setting in routine spine care. Further multicenter studies and formal psychometric validation are required before Spinoxiety can be considered an established psychological construct.