Tuesday, November 17, 2009 chris8423, Community Member, asks

Q: what is the psychological critera for spinal stimulator implantation?

my wife is currently waiting for spinal stimulator to relieve her lower back and hip pain.  was wondering what the psych evaluation consisted of.

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Answers (6)
Ladybey, Community Member
11/18/09 4:08pm

Hi,

I just had the eval done myself yesterday for the same procedure. I met with the Psychiatrist at my Spine Dr's Office and had to tell her what I knew about the SCS and how I felt about it. She wanted to know if I had done any research on it as well. She asked me what type pain level would I be happy to get, then she asked me how I would fell with a foreign object in my back. I already have the rods and screws from previous fusions, so to me it is no big deal. She wanted to know how my Family felt about this, and what my life was like growing up. She also wanted to know if I am in counseling and would I be willing to talk with a Counseor once I have the SCS implanted. Also how would I feel if the trial didn't work out for me.

That was basically it. I was all nervous not knowing what to expect, but I passed my eval and it wan't invasive to me at all.

Oh, after the eval I also had to meet with my Nurse who told me how the trial procedure will go and what happens if I have results from the trial.

I hope this helps you.

If there is anything else that I can answer for you, please let me know.

All the best to your Wife.

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chris8423, Community Member
11/18/09 5:07pm

thank you very much.  My wife has been getting delayed for her treatment by the psych. for 8 weeks he is just collecting his money and scheduling more sessions before he will decide this helps greatly.

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Ladybey, Community Member
11/19/09 6:39am

I am waiting now for my Ins. Company to approve the trial. I know that this will happen, and once I have the trial I will let you know what I experienced and what the outcome was for me. I am thinking positive thoughts and have severe back pain and issues with my back, hip, sciatica and joints as well as degenerative discs. I will be happy if I were to even get 10% relief of the constant tingling going down my leg.

I hope she is able to get in soon for her evel. Sometimes you have to get a little persistent and push for things to happen.

Good Luck :)

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chris8423, Community Member
11/24/09 9:13pm

thank you she did get right in with the psych for the evaluation but he is milking it she told him her goals where to get off the pain meds or at least reduce them and that she was looking for a 40 to 50 percent reduction in the pain.  His first response to her was he wanted to add another perscription to the 8 she already is on.  He doesn't even want to talk about the scs or the procedure we're at 8 weeks with this guy and he just wants more visits.  Did you take any kind of written test  like the mmpi  which is an evaluation test made up of 567 true and false questions for psychological evaluation?

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SCSLover, Community Member
11/19/09 8:02pm

I have had my spinal cord stimulator implant (SCS) for almost 3 years now.  I was told that the psychological testing was done to determine if you have realistic expectations of what the SCS can do.  It is very important to understand that the SCS is not a cure, but a medical device that can (and in my case does) give you a better quality of life. I don't have as much relief from pain in my lower back as I do from the nerve pain in my legs.  The stimulator works on the pain created by the damaged nerves as a result of back injuries and surgeries.

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chris8423, Community Member
11/24/09 9:21pm

did you have several visits with the psychologist or a single session.  Did he discuss the scs with you or did he want to know about your personal life? this dr. does not want to discuss the scs the pain the pain killers or general health and quality of life.  My wife has had the pain center and her family dr. pull the reports from the psych  neither can find anything in his reports to keep stalling the trial.  Just looking to see what others have gone through.  Thank You

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SCSLover, Community Member
11/25/09 4:58am

The psych evaluation was done by an independent psychologist and all he asked me was about my personal life and what my expectations were of having the SCS implanted.  I also had to complete a shortened version of the MMPI test (200 questions). All of this was done in one session.  I had to wait 2 months for insurance to approve the trial and 3 months for approval of the implant (this wait seemed like forever because I go so much relief during the trial).  My insurance company at the time said that the approval process required two review boards to process my health history, psychological evaluation, and medical necessitiy of implanting the SCS. I kept on the insurance company by calling every other week until the approval was granted.  I had to have 50% or greater reduction in pain during the trial before I could have the permanent implant done. I hope this information will be helpful to you. I am so sorry that you are also experiencing such long delays for approval. Hopefully you will get approval soon and can get the SCS trial underway. 

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Ladybey, Community Member
11/25/09 6:28am

Hi,

 I had one session with the Psychiatrist, and was asked what my expectations of the SCS were, and how I feel about a foreign object in my body, how my Family feels about it, my overall health and parts of my Childhood as well as my meds that I am on. 

What other procedures has your Wife had? I am wondering if this may be why they are stalling? If she has had several different injections, pt and has been on different meds, I would question why not try it and what is their plan.

I have my trial date set for 12/15.

Is the Dr. who isn't willing to discuss your Wifes medical condition the Psychiatrist? I was a bit confused there ( I apologize for that). If it is the Psychiatrist that is not willing to do this and the Dr's have the all of the info that they need, then I don't understand as well why they are stalling. My Orthopedic and Spine Dr. got right on top of this as soon as I passed my Psyche eval, now I see how the trial goes for me. If I don't get 50% relief with the numbness going down my leg then they consider it not a success and will remove the SCS. If it is a success I meet with the Neurosurgeon to have it implanted.

I really wish your wife the best!!!

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Bruce42545, Community Member
6/16/10 6:24pm

Dear Chris8423,

I am a clinical psychologist and do SCS and gastric bypass pre-surgical evaluations on a regular basis.  The information given to you by Karen262299 is correct.  The psychiatrist your wife has been seeing for an evaluation appears to be taking the role of her therapist.  If so, that would be inappropriate.  The purpose of the evaluation is to determine whether or not there are any psychological issues going on that would interfere with rehabilitation efforts.  This is important for your wife's benefit because it would not be wise to have any surgical proceedure done if the patient's psychological state could negate the potential benefits.  It's not really a question of "passing or failing" the evaluation.  If there are some problems that would contraindicate going through with the surgery, the recommendation typically is to remedy the psychological issue and as soon as that is accomplished, to them proceed with the surgery. The evaluation performed by most psychologists involves a clinical interview, a mental status exam, and some psychological testing.  These assessments usually take 90 minutes to two hours of the psychologist's time face to face, one to two hours or the patient's time for the psychological testing, and then another 90 minutes to two hours of the psychologist's time to analyze the results and write a report.  I hope this helps.  Good luck to your wife. 

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hopeful, Community Member
1/ 7/12 12:47pm

Greetings Bruce, I am in the early process of just finding info for the implant, and being sent for all the testing and doectors' I need to see. I your opinion, if someone has has panic attacks, would that, be an issue for denial, to proceed? I have had several major surgeries already, and much, much, hardware sugically implanted. Thanks for the insight.

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Bruce42545, Community Member
1/ 9/12 1:18pm

Dear hopeful,
Panic attacks are not likely to lead to a denial to proceed with the surgery, but it ultimately depends on how severe a panic disorder and individual has.  Some people only experience panic symptoms on a relatively infrequent basis and others experience them so often that it stops them from being able to have any degree of real functionality left in their lives.  Under most circumstances that I have encountered, people with panic symptoms are typically permitted to proceed with the surgery with a recommendation that they also become involved, at the same time, in some appropriate form of treatment to deal with the anxiety.  That would make sense even if screening for a SCS was not even an issue.  In general, the decision to proceed or not proceed with the stimulator is based on a more overall view of how well an individual is functioning from a mental standpoint.  Sometimes people are so anxious that even with a spinal cord stimulator the high level of tension adds to the likelihood of continuing pain symptoms.  With that in mind, the anxiety could therefore counteract/negate the benefits that the stimulator otherwise might have produced.  The overall answer I can give you is that usually there is no single diagnosis that automatically would cause a denial to proceed with a SCS procedure because it would be a combination of the diagnosis and the level of severity of the symptoms connected with any one particular person.  I hope that helps. Bruce

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pam dupree, Community Member
12/ 4/12 8:46pm

i had back surgery in march and he cut 2 major nerves in my left leg. then i have injections and another surgery in oct 2012 he couldnt fix me and my last thing is a never stimalater so i had to go see a psyic and i took the test and he said im not ready for surgery i dont know why,,,, and i wont to know why..... i do take depression meds. does that have something to do with it?????? this is unreal i cant work i filed for disablty and im only 46 this sucks, if anyone can help me plz respone.

 

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randy100, Community Member
11/19/09 10:47pm

I think that what is most important is if one is a good candidate for spinal cord stimulation, it works much better on some than others and that is a decsion that has to be made with your pain management specialist.

 

Psychologically speaking, I am not sure that plays that much of an importance in the whole scheme of things....more importantly, what are the risks v. the valuse of how much it may help.  And, this balance has to be weighed very carefully and you have to understand the process.

 

Most are not good candidates for SCS, there are target groups of people though with certain types of pain and in certain areas that do very well with it compared to others.  I think many don't understand the delicacy of this balance and it is quite involved.

 

I think that anyone considering it needs to look at all of the pros and cons of having SCS and, reasearch it as well as talking candidly with your pain management specialist and your other physicians.

 

SCS is done on a trial basis, usually for 1-2 weeks before the procedure is even considered to see how much relief it may provide.

 

I have been thinking about SCS since March 2007 and I am still considering it, though I have not made a decision.  In my case, I am a prime candidate for it and could get about 80% relief but....I am taking my time and if it is the right time, I think I will know that.  So, I still ponder the question of SCS, I do wish some things were not as intrusive but this one is more so and I guess lots more to consider.

 

Randy.

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buddy's mamma, Community Member
11/20/09 1:43pm

I don't know the answer to this question. I'm getting the trial placement in January and was not aware of any psych evaluation for one..does that come after the trial? My insurance has ok'd the placement for the trial..should I be asking someone?  This is kind of the last straw for me, as it is i'm sure, for most people. I hope i'm not placing to much "hope" for this..my doc has told me several times that it doesn't always work and to be prepared for that...i SO don't won't to be dissapointed, but i am also not stupid and very realistic about nerve damage from viruses. sooo we will see.

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chris8423, Community Member
11/24/09 9:01pm

everything that i have read been told or researched has required a psych evaluation prior to the scs trial even begins.  You may want to ask your doctor if you have not had this brought up to you.    Good luck

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Bonnie Jean, Community Member
2/19/11 11:06pm

I have had the trial stimulator placement and did not realize how well it worked until it was removed.  I have hurt much worse since it was removed.  I am due to have a psych. evaluation in March.  I would go ahead and have the permanent one placed today if I could.  No other questions asked.  I have been on so many medications for to long.  I am addicted to Fentanyl and I stay sleepy all the time.  I am not getting any younger and I would like to feel better if at all possible for whatever time God will allow me to live.  I feel the stimulator may help with that.  No, it's not a cure, but it is a help.  Even with all of the medications, I wake up in the night in pain.  When I had the trial stimulator, I didn't do that.   It helped a great deal.  Will I ever be completely without pain - no - but it will be decreased much more than what I have now.  I am thankful that someone was smart enough to come up with this idea.  The person who is waiting to have it put in, must not be in, as much pain as some of the rest of us.  I've been fighting this for years and it's getting worse every day.  I say go for it.  Do the psych. eval. then do your trial - nothing ventured, nothing gained.

God bless you and hope all works out for all of you. Smile and for me too Wink

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karen262299, Community Member
11/26/09 3:01pm

I had my trial about a year ago.  My pain specialist (who is a bit of a smart ass) said the psych evaluation was necessary to make sure that if I had a device implanted in my body, I would not think "ET was trying to phone home". 

 

The psychiatrist he sent me to does these evaluations for several different pain management practices and specialized in pain management himself.  He had me take 3 written tests then, after going over them, talked to me about my pain history and my expectations for the implant.  The whole thing took about 2 hours.  He told me I was approved for the trial before I left his office. 

 

Your wife needs to talk to her pain management doctor and tell him what is going on.  Sounds like the psychiatrist is just trying to become her therapist.  Even if she does need therapy, it is not his place to make that decicion for her (the doc that did my eval did recomend that I see someone for my depression - which had been diagnosed several years ago).  Have the pain doctor refer her to a different psychiatrist for the evaluation - preferably one who specializes in pain management!  He should also let the psychiatrist know that he won't be refering any more patients and why!  Good luck!

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dwdrummer, Community Member
7/13/12 10:15am

   It's all about the money. I am about to have a spinal stimulator implanted myself

at Duke Medical Center. I asked the evaluating psychiatrist why it is necessary to

take these long and expensive test. She had no answer but gave me a bunch of b.s. which is an insult to one's intelligence. Apparently, if a person complains of

severe pain, (even though the damaged nerves are clearly seen on any m.r.i.), the

doctor immediately assumes the patient is a lunatic and drug addict. 

 

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Daniel, Community Member
10/ 3/12 11:45am
I am going to Duke Friday to see a neruosergeon about having a spinal cord stimulator. What does the psychiatrist ask and do you have to take any type of test? Good luck on your implant. Reply
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By chris8423, Community Member— Last Modified: 02/11/14, First Published: 11/17/09