Obtaining psychological clearance before you begin a trial period of spinal cord stimulation is routine, but many people are unsure about why this is such an important step.
Spinal cord stimulation uses electrical current to minimize the feeling of pain reaching the brain. It involves insertion of small devices in the area around the spinal canal, which send the current when activated.
Following are a few common questions people ask about the required screening session with a neuropsychologist and how the results can be used to help meet your needs.
Q: Does a referral to a neuropsychologist mean my surgeon thinks I’m crazy or will go crazy after the stimulator placement?
A: No, but not everyone responds well psychologically when a foreign device is implanted into their body. For some, the stimulator can cause an increase in worry and anxiety. Unfortunately, this stress can reduce the effectiveness of the simulator placement. In part, the pre-surgical clearance examination helps your physician prepare you for the procedure and make recommendations to help you adjust to this new part of your body.
Q: What happens during the pre-surgical psychological examination?
A: Sometimes patients who have never met with a psychologist before get anxious about the initial visit. Knowing what to expect can help decrease worry.
Typically, the examination consists of a conversation between you and the psychologist about your medical history, including your chronic pain struggles. It also involves a social history, family history, information about previous alcohol or substance use, and what kind of psychological treatment you may have had in the past.
You’ll also fill out a few questionnaires about how you manage your pain, your current mood, and your treatment goals. The conversation remains confidential between you and your psychologist unless you disclose that you plan to hurt yourself or someone else. In order for the psychologist to share the information with your surgeon, you will need to sign a release form.
Q: What if I am depressed or anxious? Will that stop me from having the stimulator placement?
A: No. In fact, chronic pain patients are much more likely to suffer from depression and anxiety than the general public. It is typical and expected that people living with chronic pain will have high levels of irritability, anxiety, and depression.
Also, pain relief often helps decrease depression and anxiety. If you are struggling with depression and/or anxiety, the pre-surgical clearance evaluation will offer recommendations to help diminish these feelings.
Q: Can the psychologist make other recommendations besides the stimulator?
A: Yes. The psychologist can be a valuable member of your pain management team. Many people find that alternative or complementary treatments, such as biofeedback and mindfulness approaches, can be helpful in helping manage chronic pain. Psychologists can guide people in these therapies as well as provide traditional psychological counseling.
Q: How long is the appointment and can the screening usually be done in a single appointment?
A: Typically, an evaluation takes two hours and—depending on your insurance—can be done in one appointment. Following the evaluation, the results are shared with you and your physician.
Q: Are most people cleared to proceed with spinal cord stimulation?:
A: While most people are cleared to have the trial placement of the stimulator, a small number of people are not. Those who are experiencing hallucinations, delusions, and cannot understand and follow post-operational directions should not have a stimulator. Instead, complementary and holistic interventions such as mindfulness, cognitive-behavioral therapy, or biofeedback may be a more effective option for pain management.