Psychiatric screening for spinal cord stimulation for complex regional pain syndrome: A literature review and practical recommendations for implementation
Anurag Modak, Raja Jani, Sushma Jani, Antonios Mammis
Abstract
Spinal cord stimulation (SCS) is a well-established, efficacious treatment option for patients suffering from complex regional pain syndrome (CRPS). Psychiatric comorbidities have been shown to be associated with worse SCS outcomes and thus appropriate screening questionnaires have been used to select candidates. This manuscript aims to examine the existing literature regarding the ability for psychiatric screening tools for SCS to adequately identify psychiatric contraindications to SCS and to propose an evidence-based treatment algorithm. Fifteen different psychological screening tools were identified that are used to assess SCS patients. Analysis of the literature revealed the following psychological factors predisposed patients to SCS failure: depression, anxiety, somatization, catastrophizing, poor coping mechanisms, dysfunctional interpersonal relationships, childhood trauma, and elevated pain perception. There was inconclusive evidence regarding the association between the scores from most psychological tests and the aforementioned predisposing factors or SCS outcomes. Based on the existing literature, our group recommends the Beck Depression Inventory (BDI)-II as the primary psychological screening tool for CRPS patients being considered for SCS. Patients with a BDI-II score > 28 should be counseled to undergo cognitive behavioral therapy (CBT) and seek psychiatric care prior to consideration for SCS.