The Psychological Assessment of Candidates for Spinal Cord Stimulation for Chronic Pain Management

Abstract

It is known that, in spite of meeting appropriate clinical criteria for spinal cord stimulation (SCS) and having undergone flawless procedures, a significant number of patients who fail the therapy continues to exist. It is the purpose of this article to focus on the development of psychosocial indicators of success for SCS, if any. Referring to specialist literature authors present a review of what is known, what is not known, and what remains controversial on this topic. After reading this article we hope the reader will understand the importance of a psychological evaluation as part of the development of standards for identifying appropriate patients for this therapy. To improve treatment outcomes of SCS, seems to be essential to perform psychosocial evaluations on all persons clinically indicated for SCS to exclude those patients, who most probably, on a psychosocial level, will fail the procedure. To maximize treatment efficacy, authors believe spinal cord stimulation for chronic pain control must be part of a comprehensive program. An accurate preoperative psychosocial assessment and a course of psychological assistance both before and after therapy seems to be crucial for improving outcomes.

Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

“…This assessment of cautionary risk factors is similar to that proposed by Block and colleagues (Block, 1996;Block et al, 2001Block et al, , 2003. Surprisingly though, studies utilizing Block's approach do not reference the SCS literature, and the SCS literature does not reference Block's approach (Beltrutti et al, 2004;Doleys et al, 1997;Nelson et al, 1996;Williams, 1996).…”

“…In 2004, the European Federation of International Association for the Study of Pain Chapters presented a consensus document on exclusionary criteria for SCS (Beltrutti et al, 2004) This model was simpler than that proposed by Nelson (Nelson et al, 1996), Doleys (Doleys & Olsen, 1997a) and Williams (Williams et al, 2003) ( Table 1), in that it focused only on the first tier of exclusionary risk factors, and not on the second tier of cautionary risks. Overall, the weakness of this and other SCS approaches to patient selection is that they all lack something which is central to Block's (Block et al, 2003) method: a defined method of tallying the cumulative effect of multiple mild to moderate risk factors, and determining what constitutes a high score.…”

“…These models pay much more attention to the problem of serious psychopathology, and also address risk factors specific to SCS (Beltrutti et al, 2004;Doleys & Olsen, 1997b;Nelson et al, 1996;Williams et al, 2003). It was reported by Beltrutti and colleagues (2004) that in 1993, North and colleagues suggested that certain psychological and behavioral characteristics should exclude a patient from consideration for SCS, even if that patient was a good candidate from a medical perspective.…”

“…Beltrutti et al, 2004;Doleys & Olsen, 1997a;Kidd & North, 1996;Nelson et al, 1996;Williams, Gehrman, Ashmore, & Keefe, 2003). Instead, Block's method focuses on general spinal surgery research, and it is unclear how this applies to other medical treatments.…”

“…In the present study, this model was used to organize the risk factors identified by research and the biopsychosocial protocols reviewed in this paper. Using the conceptual framework supplied by the vortex paradigm and a twotiered approach, this list of risk factors attempts to create a synthesis of the risk factors identified by the Beltrutti (Beltrutti et al, 2004), Block (Block et al, 2003), Doleys (Doleys et al, 1997), Kidd (Beltrutti et al, 2004), Nelson (Nelson et al, 1996), and Williams (Williams, 1996) protocols. This resulted in the list of risk factors in Tables 3 and 4.…”