Presurgical Psychological Assessments as Correlates of Effectiveness of Spinal Cord Stimulation for Chronic Pain Reduction.

ABSTRACT

BACKGROUND: Spinal Cord Stimulator (SCS) is a surgically implanted device for patients with certain types of chronic pain. While some studies show the value of psychological screening of potential SCS candidates, no consensus exists. This single-site study analyzed the association of SCS success with psychological assessments (e.g., Millon Behavioral Medicine Diagnostic), beliefs regarding SCS efficacy, self-reported pain and quality of life (QOL) among patients approved for SCS. METHODS: Potential SCS candidates (N = 200) were contacted 3-7 years after initial psychological and medical clearance for SCS; 59 consented to a structured telephone interview. Thirty-four of the 59 had received a SCS; 25 had not received a SCS. Of the 34 that had received a SCS, 22 were approved by routine psychological evaluation while 12 went through in-depth psychological testing. RESULTS: The majority of respondents (62%) reported effective pain reduction, and 64% of SCS recipients reported improved QOL. Younger patients reported higher pre-implantation pain scores, and participants with higher levels of pain preimplantation were more likely say they would undergo the procedure again. Finally, persons reporting preoperative alcohol problems were more likely to report lower levels of post-SCS pain. CONCLUSION: Predictors of pain relief and QOL following SCS may depend on expectations of the device and on individuals' interpretation of pain or psychosocial health.