Doctors Lounge - Orthopedics Answers
provided on www.doctorslounge.com is designed to support, not
replace, the relationship that exists between a patient/site
visitor and his/her physician."
Back to Orthopedics Answers List
- Wed Dec 02, 2009 7:23 pm
I had 360 spinal fusion with cage implants at L3-l5 approximately 18 months ago. The surgery has failed and I am now in a great deal of pain all the time. I have had numerous epidural injections, and nerve branch blocks with little success. My pain management Dr sugguested I get a Spinal Cord Stimulator implant and after researching and talking with my Back Surgeon I agreed. I have been on strong narcotics for a long time now and we both believe that decreasing those levels would be beneficiary to me so the SCS seemed the way to go.
Well they informed me that I will have to have a Pych eval in order for me to get the SCS. I am on disability for Bipolar Disorder, and panic disorder will this prevent me from passing the eval and getting the SCS?
I don't want to spend the rest of my life taking all these medications and would like to be able to function at a normal level so this has me concerned.
Thanks in advance
| Dr.M.Aroon kamath
- Fri Jan 01, 2010 12:12 pm
Spinal cord stimulation (SCS) can be described best as an 'analgesia on demand'.It is
- usually used when other options fail.
- it reduces the cost of pain medications, their side effects & the cost of treating those side effects.
The disadvantages are,
- it is effective only in about 50–70% cases,
- it is an invasive procedure, with potential complications such as bleeding,infections, dural puncture, risk of disconnection or equipment failure.
In any type of surgery, one very basic consideration is 'patient selection'. Better the patient selection, the results are generally believed to be superior in terms of 'patient satisfaction'.
Psychological/psychiatric evaluation is a part of patient selection. For certain procedures, the patient selection is more stringent than in others.
In the case of Spinal cord stimulation,the need for a psychological evaluation has been driven largely by insurance requirements.
There is a lot of controversy among specialists in pain management as to the role of psychological evaluation as a prerequisite for SCS.The ability of a psychological assessment to predict outcomes, has been questioned by some.Others point to the estimated 20% of all patients (in some studies) found misrepresenting their response to 'trial stimulation' of the spinal cord before definitive SCS. Based on this observation, some feel that psychological testing may not add significantly to the elimination process.
In some countries psychological testing is mandatory.For example, studies from belgium have shown that psychological testing does enhance the % of successful outcomes.
Pain is not a diagnosis but a symptom.The diagnosis is the primary indication for SCS. If the diagnosis is uncertain,the mechanism of the pain should be determined ( ?ischemic, ?neuropathic) to aid in decision- making.
Ischaemic pain responds most predictably to SCS. Many neuropathic pains do respond, but unpredictably. A psychiatric opinion does help in case selection.
So, at present,there seems to be no consensus regarding the status of psychological/psychiatric testing in patient selection in individuals with psychiatric illnesses for SCS.