Psychological factors in spinal cord stimulation therapy: brief review and discussion

Daniel M. Doleys
2006 Neurosurgical Focus  
The most common reason for failure of stimulation techniques to relieve pain is the psychological status of the patient." (Donlin Long, 1985) ORE than 40 years ago, Shealy and colleagues 47,48 introduced the concept of SCS based on Melzack and Wall's gate-control theory of pain. 34 This theory and its subsequent iterations allow for the role of psychological factors, including affective and cognitive components, in the modulation of pain. According to a report by North and Wetzel, 40 this may
more » ... tzel, 40 this may have been the impetus for Shealy et al. to recommend the following selection criteria for patients to receive SCS: 1) emotional stability; 2) elevation of the depression scale score only (Scale 2 [D]) on the MMPI; and 3) cooperation with a rehabilitation program. Since its introduction, there has been an explosion in available SCS hardware and device options, computer modeling of stimulation parameters, theories of mechanism(s) of action, and the variety of disorders treated. 2, 30, 32, 40, 41 Scores of studies involving thousands of patients have been published. However, reviews of the literature 10,29,50 have indicated a reported loss of pain relief in up to 50% of patients at 1 to 2 years postimplantation, despite a successful trial period of stimulation. In one KEY WORDS • pain • depression • spinal cord stimulation • psychological screening 1 Abbreviations used in this paper: BDI = Beck Depression Inventory; CRPS = complex regional pain syndrome; MMPI = Minnesota Multiphasic Personality Inventory; QOL = quality of life; SCS = spinal cord stimulation. M Unauthenticated | Downloaded 07
doi:10.3171/foc.2006.21.6.4 pmid:17341042 fatcat:hbtmrpnyzjh4hkfsklyyhjjxxi