Patient selection for spinal cord stimulators: mental health perspective

Research has shown that psychosocial factors can predict poor outcome for spinal cord stimulation (SCS) for patients with chronic pain, substantiating the need for standardized assessment techniques to incorporate psychosocial factors in patient selection. Presurgical psychological assessment is often required for SCS. Best practices include clinical interviews by psychologists and use of standardized measures of psychosocial risk factors. Psychologists should assess mental health and social risk factors, as well as an individual's understanding of SCS and expectations for pain relief, while consulting with physicians to support a multidisciplinary based patient selection. In addition, psychologists take part in preparing patients who were initially deemed unsuitable for SCS by providing recommendations and potential access to clinical care addressing psychological issues in chronic pain. Barriers to presurgical psychological assessments include limited access to skilled psychologists and issues with feasibility and appropriateness of standardized measures, and further work is needed to improve standardized methodology.