Psychological considerations in the surgical treatment of patients with chronic pain

Implantable pain management devices are becoming increasingly popular. The success of these devices, however, often depends on psychological factors being screened out prior to or addressed concomitantly with implanting the device. Currently there is little consensus in practice regarding the parameters of the screening process. A review of the literature is presented that reveals many psychological and behavioral risk factors for implanted pain management devices. However, little consistency exists in how these risk factors have been addressed, and a few attempts actually categorize the level of risk these factors pose to the neurosurgical procedures. Based on the literature review, this article provides recommendations for clinical decision making that transforms the psychological screening process into one that both facilitates patient selection, and enhances the development of a long-range treatment plan that can include preimplant preparation to help convert marginal implant candidates into those more likely to benefit from these procedures. Future practice in this arena will need to emphasize physicians' routine use of psychological screening prior to implantation, gaining comfort in recommending screening to patients, and integrating screening and preimplant preparation into practice. Future research in this area will need to include more randomized clinical trials of screening effectiveness, preimplant preparation effectiveness, and the development of uniform criteria for success. © 2003 Lippincott Williams & Wilkins, Inc.

Duke Scholars

Author Francis Joseph Keefe Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...