The Association of Pre-Procedural Psychological Evaluations on Post-Procedural Pain Control in VA Patients Who Received Spinal Cord Stimulator Therapy

Abstract

Introduction: Spinal cord stimulators (SCSs) are intended to treat chronic pain and are marketed as an opioid alternative. Patients require psychological screening prior to device placement to ensure the patient has an ideal profile that would lead to the device’s being effective. There is variation in the quality of pre-procedure psychological evaluations (PPPE), which may be associated with post-procedure pain (PPP) control. This fact is significant given that psychological evaluations are not currently regulated. Varying implementation of PPPE subsequently leads to variation in clinical practice and outcomes where patients may not achieve the desired outcome. Aim: This research is a retrospective, longitudinal, cohort study using secondary data collected from the electronic medical record (EMR) in an ambulatory pain clinic of patients who received SCS implants. The purpose of this study is to examine the association between the quality scores of PPPE and PPP control. We hypothesize that patients who had a poor-quality score of PPPE also had less PPP control, possibly due to being misclassified as an appropriate candidate for the device. The following aims are proposed to achieve the purpose: 1. Examine the association between the quality score of PPPE and PPP (average pain score 2 to 6 weeks post SCS placement). 2. Determine the association between the quality score of PPPE and PPP improvement (comparing pre SCS and post SCS pain scores). Methods and analysis design: For aim 1, a bivariate correlation will be utilized to determine if PPPE quality scores and PPP scores are related. For aim 2, a logistic regression will be utilized to analyze the quality scores of PPPE and PPP improvement, since the outcome variable will be dichotomous (improved or not improved). If necessary, an adjusted model, or interaction model, will be considered to look for interaction among covariates, such as age. This study would need a sample size of 123 to be powered at 80% with a .05 significance level. Ethics and dissemination: The novel information gathered through this research intends to assist clinicians in identifying optimal candidates for SCS devices and may reveal common factors in patients who are successful in achieving improved pain control after spinal cord stimulator placement.