Pre-Surgical Psychological Clearance for a Spinal Cord Stimulator (SCS) Trial

Have you been recommended a spinal cord stimulator (SCS) trial implantation by your treating physician? Are you wondering what to expect from the required pre-surgical psychological evaluation? Are you asking yourself, why is a psychological evaluation even required? Well then, read this article, you shall.


What is a Spinal Cord Stimulator?

In brief, an SCS trial is usually recommended to patients by a medical provider after all other conservative forms of medical treatment have failed to provide an optimal level of pain relief. Conservative treatment may include medication(s), injection(s), physical therapy, or other non-surgical treatments. Essentially, spinal cord stimulation may help relieve pain and improve the quality of life in people with chronic pain, such as low back and leg pain. Spinal cord stimulation works by blocking pain signals in nerves from reaching the brain, where pain is processed (Highsmith, 2019). A spinal cord stimulator is a small device implanted under the skin, which then delivers a slight electrical impulse that masks or changes pain signals before they reach the brain (Highsmith, 2019). The SCS trial period, which usually lasts at least 5 to 7 days, determines whether the permanent version of the treatment will be beneficial to the patient.


Both the SCS trial and permanent procedures are considered to be minimally invasive. Permanent implantation is, well, permanent; thus, full commitment is required from the patient. As with any procedure, there are both benefits and risks with an SCS implantation, and not all patients with chronic pain are considered to be treatment candidates. Therefore, it is highly recommended that patients obtain an adequate understanding of the procedure, risks, and expectations from the referring physician.


What Should I Expect with A Pre-Surgical Psychological Evaluation?

Among the factors considered to determine whether a patient is an appropriate candidate for the SCS trial implantation, includes the patient’s mental health. An abundance of studies have shown that the presence of certain mental health symptoms and/or conditions may affect the outcomes of some surgical procedures, such as the SCS implantation (Bruns & Disorbio, 2009; Celestin, Edwards, & Jamison, 2009; den Boer et al., 2006). Thus, most insurance companies, and even some states, now require pre-surgical psychological clearance for SCS implantation.


Typically, the psychological evaluation consists of a clinical interview between the patient and a trained psychologist to discuss the patient’s medical, social, family, education, and mental health history. Questionnaires, and/or psychological tests, are provided to obtain more information about how the patient manages his or her pain, mood, and overall daily functioning. In general, chronic pain patients are more likely (i.e., four times more likely) than the general public to experience symptoms of depression, irritability, and anxiety (Kleiber, Jain, & Trivedi, 2005). The pre-surgical psychological evaluation can offer recommendations to help improve these symptoms. The appointment time for an evaluation usually takes up to three hours and is completed in one appointment. However, depending on the individual’s needs, the appointment may take longer. Ultimately, most people are cleared for the SCS trial. The small percentage of individuals who do not get cleared are recommended alternative ways of managing their pain.


If you are considering the SCS trial to help manage your pain, please consult with your pain management specialist and/or treating physician to explore if this treatment would be beneficial to you. If you are already scheduled for your pre-surgical psychological evaluation at PNBC, please feel free to ask your evaluating psychologist any remaining questions you may have.


Written by Angela Patino, PsyD. Dr. Patino is a psychologist at Pacific Neurobehavioral Clinic, PC.



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