Psychological factors fluctuated over the 8-month follow-up period. Some psychological variables, including anxiety and depression, were significantly associated with, and predictive of, work instability. Longitudinal analysis should further identify how these psychological attributes impact on work instability and potential job loss in the longer term.

Introduction: In this prospective, multicenter, double-blinded, randomized, crossover study, we compared the therapeutic efficacy of burst SCS delivered using a lead implanted with the paresthesia mapping approach to a lead implanted with an anatomic placement approach. Materials and Methods: Subjects with chronic low back pain were implanted with two leads, one using paresthesia-mapping approach (PM) and the second using anatomical placement procedure (AP). Stimulation contacts were chosen using the standard intraoperative paresthesia-testing procedure for the paresthesia-mapped lead or an activated bipole overlapping the T9-T10 junction for the anatomical lead. Amplitude for either lead was selected such that no sensory percepts were generated. Subjects were assessed at baseline and after a trial period during which they tested each lead for two weeks in random order. Eligible subjects had the option to receive permanent implants using their preferred AP or PM approach at end-of-trial. Results: Of the 53 subjects who completed both trial periods, 43 (81.1%) experienced at least 50% back pain relief with at least one lead. Nearly half of these (20; 46.5%) were profound responders who experienced at least 80% back pain relief with either leads. Primary and secondary outcomes, at the end of trial, showed significant improvements for both AP and PM leads from baseline yet were not significantly different from each other. Discussion: The trial results of this study suggest that similar clinical outcomes can be achieved in burst SCS when performing lead placement either using paresthesia mapping or anatomical placement with imaging references.

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For people with MS (PWMS) the relationship between job retention and psychological factors is unclear. This may lead to psychological interventions to aid job retention. This study aims to investigate relationships between psychological factors, work instability and MS in a longitudinal prospective study of PWMS in paid employment.Participants completed two time point questionnaire packs of validated scales with repeat testing planned. 221 employed PWMS were recruited. Mean age was 40.6; 75.1% were female. 91% had relapsing-remitting MS (RRMS). 213 (96.4%) completed the baseline questionnaire, 199 completed month 8. Disease progression was mostly stable with just 3% transitioning from RRMS. 57.2% were at medium/high risk of job loss, with only marginal changes in work instability at 8 months. 14% reported high physical and psychological impact of MS at baseline which remained unchanged. There was a strong association between risk of job loss and both physical and psychological variables. Some psychological variables fluctuated, e.g. depression fell from 24.6% to 14.5%. No changes were reported in levels of fatigue or pain over this period.Psychological attributes in MS appear to fluctuate but contribute to work instability. Further investigation will clarify this relationship and inform possible intervention strategies.

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