The Use of Preoperative Psychological Evaluations to Predict Spinal Cord Stimulation Success: Our Experience and a Review of the Literature.
BACKGROUND
Pre-operative psychological assessment is commonly used to assess patients for spinal cord stimulation (SCS). Though often times mandated by insurance, its value is frequently questioned.


METHODS
We review the literature on the predictive value of psychological testing prior to SCS and retrospectively examine our prospective database of SCS patients. We examine associations of Minnesota Multiphasic Personality Inventory (MMPI), Beck Depression Inventory (BDI), and Pain Catastrophizing Scale (PCS) findings and outcomes on the visual analog scale (VAS), McGill Pain Questionnaire - Short Form (MPQ), and Oswestry Disability Index (ODI) at 6 and 12 months post-implantation.


RESULTS
The nine studies examining psychological predictors of SCS outcomes collectively showed that substance abuse or feelings of demoralization or less joy correlated with worse outcomes. Though not statistically significant, our data show that at one year follow-up, patients without psychiatric disorders improved 1.5 times as much on ODI and 2.4 times as much on PCS as compared to patients with psychiatric disorders. Further, depressed patients concurrently treated with anti-depressants had greater improvement in BDI than non-medicated depressed patients (p = 0.009). We develop a tool for pain psychologists based on the existing literature to aid in identifying possible concerns and treating these patients peri-operatively.


CONCLUSIONS
The predictive value of psychological testing depends on which psychiatric factors are used and which outcomes are measured. The predictive capacity of psychological indications can be used to holistically treat patients, specifically to recommend psychiatric medication and consulting to supplement SCS treatment as needed.
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Christopher A
CA
Fama
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Nita
N
Chen
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Julia
J
Prusik
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Vignessh
http://orcid.org/0000-0003-2032-294X
V
Kumar
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Meghan
M
Wilock
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Steven
S
Roth
Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.|Center for Neuroscience and Neuropharmacology, Albany Medical College, Albany, NY, USA.
Julie G
JG
Pilitsis
D004185:Disability Evaluation; D006801:Humans; D010146:Pain / Q000523:psychology*; D059408:Pain Management; D010147:Pain Measurement; D011446:Prospective Studies; D062187:Spinal Cord Stimulation / Q000379:methods*; D016896:Treatment Outcome
Depression index; neuromodulation; psychiatric factors; psychological evaluation; spinal cord stimulation