Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Chronic Neuropathic Pain
Psychological Factors
Is it beneficial to conduct a psychological evaluation and when should this take place?
We lack sufficient information to predict SCS outcome from the result of a pre-treatment psychological evaluation, but SCS, as is the case for every interventional pain treatment, is reserved for patients with no evident unresolved major psychiatric comorbidity. Moreover, the psychological evaluation helps identify the small percentage of patients who might benefit from psychological treatment before undergoing SCS therapy or in whom SCS therapy might be complicated by psychological factors. Just as organic disease can influence the results of psychological testing (by influencing a patient’s state of mind), underlying psychological factors can influence the course of organic disease. Thus, it is common for patients with chronic pain to have secondary, if not premorbid, psychological co-morbidities, and it is routine for a mental health professional to determine if a candidate for SCS has such co-morbidities or is engaging in inappropriate drug use. Medicare requires a psychological evaluation before SCS implantation, and many private insurers follow this example.
Some practitioners perform a percutaneous screening trial before the psychological evaluation takes place; however, the psychological evaluation can reveal a reason to postpone the screening trial or other information that would be beneficial at the initial stage of treatment. The psychological evaluation must, however, occur before a patient undergoes a screening trial with a surgically-placed electrode (a percutaneous electrode anchored for potential use in a permanent system or an electrode implanted via laminectomy or laminotomy) or before a patient receives a complete implanted SCS system.
| Strength of recommendation | Evidence source(s)/rationale |
| A = Recommended or required Valid, useful, or non-negotiable |
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Possibly prognostic psychological factors
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Abstract | Wikistim Entry
Psychological assessment tools
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