Background & Aims

The literature base surrounding presurgical psychological evaluation spans over 50 years. Shealey and colleagues (1967) originally proposed that spinal cord stimulation could prove beneficial for chronic pain based on Melzack and Wall’s Gate Control Theory of Pain (1965). Since that time, significant advancements have been made in surgical techniques, software, hardware and the variety of disorders for which SCS has been proven potentially beneficial. Despite these advancements, however, many patients do not have successful trials, implants or report loss of analgesia over time. Psychological factors play an important role in understanding these trends and improving the outcomes. This presentation will provide a literature review of presurgical psychological assessment guidelines from past to present, address what psychological factors are, and the evidence based tools for assessing them. Positive and negative sequelae of specific psychological factors will also be discussed.

Methods

The practice of assessing presurgical psychological risk is used across medicine to help predict the outcome of surgery and interventional procedures. In pain medicine, several neurostimulation procedures require pre-surgical psychological assessment, including spinal cord, dorsal root ganglion and deep brain stimulation. Quantifying psychological risk is a mandated insurance requirement for all neurostimulation techniques. These evaluations require a biopsychosocial assessment of the individual along with evidence-based psychological testing. The standard of care for conducting presurgical psychological evaluations will be considered, using spinal cord stimulation as an example, and best practice guidelines will be discussed. Examples of assessment tools, their limitations and benefits, will be shared.

Results

The consideration of psychological factors and associated tests when considering spinal cord stimulation therapy incorporates the multidimensional nature of pain (involving sensory, affective, and evaluative components), as well as the relationship and influence of psychological factors on the experience of and adaptation to pain. Risk assessment also involves understanding that the sole presence of psychological factors is not predictive of their relevance without consideration of severity and the biopsychosocial impact of these factors on the individual undergoing the assessment. This session will share the prevalence of mental health comorbidities in chronic pain, the impact of mental health factors on chronic pain, the state-of-the-art assessments to use in presurgical risk identification, and what precise mental health factors and behaviors are the most crucial to evaluate and weigh during presurgical risk evaluations.

Conclusions

Presurgical psychological evaluations are a mandated step of consideration for spinal cord stimulation therapy. The history and rationale for these evaluations span over 50 years and are based in psychological research. In 2020, IASP reviewed this research and revised its definition of chronic pain to include biological, psychological, and social factors. The experience of pain is now recognized as highly individual, and learned, and can have adverse effects on psychological well-being. As such, individualized approaches for patient selection for implantable procedures are important and can be predictive of poor outcomes in pain procedures. The basis and history for presurgical evaluations for neurostimulation, including spinal cord stimulation, will be discussed. The use of presurgical psychological evaluations to identify risk factors for poor outcomes and predict the longevity of procedure effectiveness is a vital component to the overall success of neurostimulation procedures.

References

1.Beltrutti D, Lamberto A, Barolat G, et al. The psychological assessment of candidates for spinal cord stimulation for chronic pain management. Pain Prac. 2004; 4(3) 204-221. doi:10.1111/j.1533-2500.2004.04305.x

2.Duarte RV, Houten R, Nevitt S, et al. Screening Trials of spinal cord stimulation for neuropathic pain in england- A budget impact analysis. Front. Pain Res. 2022; 3: 974904. doi:10.3389/fpain.2022.974904

3.Celestin J, Edwards RF, Jamison RN. Pretreatment psychosocial variables as predictors of outcomes following lumbar surgery and spinal cord stimulation: A systematic review and literature synthesis. Pain Med. 2009; 4(10) 639-653. doi:10.1111/j.1526-4637.2009.00632.x

4.Powell R, Scott NW, Manyande A, et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia (Review). Cochrane DB Sys. Rev. 2016; 5: 008646. doi:10.1002/14651858.CD008646.pub2

5.Turk DC, Dworkin RH, Allen RR, et al. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain. 2003;106(3):337-345. doi:10.1016/j.pain.2003.08.001

6.Kubu, C. The role of a neuropsychologist on a movement disorders deep brain stimulation team. Official J Nat. Acad. Neuropsychol. 2018; 33: 365-374. doi:10.1093/arclin/acx130

7.Deer TR, Grider JS, Lamer TJ, et al. A systematic literature review of spine neurostimulation therapies for the treatment of pain. Pain Med. 2020;21(7): 1421-1432. doi:10.1093/pm/pnz353.

8.Block AR. Demoralization, patient activation, and the outcome of spine surgery. Healthcare (Basel). 2016;4(1):11. doi:10.3390/healthcare4010011.

9.Theologis AA, Ailon T, Scheer JK, et al. Impact of preoperative depression on 2-year clinical outcomes following adult spinal deformity surgery: the importance of risk stratification based on type of psychological distress. J Neurosurg Spine. 2016;25(4): 477-485. doi:10.3171/2016.2.SPINE15980

10.Vu TN, Khunsriraksakul C, Vorobeychik Y, et al. Association of spinal cord stimulator implantation with persistent opioid use in patients with postlaminectomy syndrome. JAMA Netw Open. 2022;5(1): 2145876. doi:10.1001/jamanetworkopen.2021.45876.

11. Bruns D, Disorbio JM. The psychological evaluation of patients with chronic pain: A review of BHI 2 clinical and forensic interpretive considerations. Psychol Inj Law. 2014;7(4):335-361. doi:10.1007/s12207-014-9206-y

12.Doleys DM. Psychological factors in spinal cord stimulation therapy: Brief review and discussion. Neurosurg Focus. 2006;21(6): E1. doi:10.3171/foc.2006.21.6.4.

13.Witkam RL, Kurt E, van Dongen R, et al. Experiences from the patient perspective on spinal cord stimulation for failed back surgery syndrome: A qualitatively driven mixed method analysis. Neuromodulation. 2021;24(1):112-125. doi:10.1111/ner.13277.

14.Jones CMP, Shaheed CA, Ferreira G, et al. Spinal cord stimulators: An analysis of the adverse events reported to the australian therapeutic goods administration. J Patient Saf. 2022;18(5):507-511. doi:10.1097/PTS.0000000000000971.

15.Ramezani A, Johnson M, Alvani SR, Odor A, Hosseinpoor S. The P3-model of perioperative psychological preparation: Pre-surgical and pre-medical procedural psychological preparation and psychophysiological interventions. Clin Neurol Neurosurg. 2022; 222: 107468. doi:10.1016/j.clineuro.2022.107468.

16.Fama CA, Chen N, Prusik J, et al. The use of preoperative psychological evaluations to predict spinal cord stimulation success: Our experience and a review of the literature. Neuromodulation. 2016;19(4):429-436. doi:10.1111/ner.12434

Presenting Author

Geralyn Datz

Poster Authors

Geralyn Datz

PhD

Southern Behavioral Medicine Associates PLLC

Lead Author

Rachel Lawrence MA

University of Southern Mississippi

Lead Author

Kimeron Hardin

PhD ABPP

American Assocciation of Pain Psychology

Lead Author

Topics

  • Treatment/Management: Interventional Therapies – Neuromodulation