Associations Between Pre-Implant Psychosocial Factors and Spinal Cord Stimulation Outcome

Abstract

Spinal cord stimulation (SCS) has variable effectiveness in controlling chronic pain. Previous research has demonstrated that psychosocial factors are associated with diminished results of SCS. The objective of this investigation is to examine associations between pre-implant psychological functioning as measured by the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and SCS outcomes. SCS candidates at two sites (total N = 319) completed the MMPI-2-RF and measures of pain, emotional distress, and functional ability as part of a pre-implant psychological evaluation. At an average of 5 months post-implant, patients completed the measures of pain and emotional distress a second time. Poorer SCS outcomes and poorer patient satisfaction were associated with higher pre-implant MMPI-2-RF scores on scales used to assess emotional dysfunction, somatic/cognitive complaints, and interpersonal problems. Ways through which pre-implant psychological evaluations of spinal cord stimulator candidates can be informed by MMPI-2-RF findings are discussed.

Use of a Psychological Evaluation Tool as a Predictor of Spinal Cord Stimulation Outcomes

“…Sparkes et al demonstrated that autonomous coping and depression were shown to significantly correlate with improvements in VAS ( p < 0.001), ODI ( p = 0.011), anxiety ( p = 0.042), and depression ( p = 0.010) at 12 months . Block et al showed patients with aberrant negative thoughts, emotional internalizing disorder, and substance abuse were found to have a greater risk of not having their SCS expectations met or being dissatisfied with SCS . In contrast, Burchiel et al showed there was no direct correlation between outcome and psychological status in 34 patients at 3 months .…”

The Use of Preoperative Psychological Evaluations to Predict Spinal Cord Stimulation Success: Our Experience and a Review of the Literature

“…Improvement in VAS by 50% at three months correlated with improved capacity for joy, as measured by DABS at a mean of five years follow‐up . In one study, pre‐operative sleep interference and pain self‐efficacy correlated with pain reduction of 50% or more, as measured by NRS . Significant preoperative measures that contributed to successful outcomes (defined as >50% pain reduction using NRS) include sleep interference using a 10‐point scale ( p = 0.026), depression using HADS ( p = 0.042), PCS ( p = 0.042), and PSEQ ( p = 0.0299) .…”

Determinants for Meaningful Clinical Improvement of Pain and Health-Related Quality of Life After Spinal Cord Stimulation for Chronic Intractable Pain

“…The reduced efficacy of SCS was attributed to technical factors that result in the loss of target area paresthesia and analgesic efficacy . However, recent studies suggest that the contribution of psychological factors also should be considered when investigating SCS efficacy . Chronic pain generally begins as a biological process, but psychological and social factors often play key roles in the development and experience of chronic pain.…”