A Systematic Literature Review of Psychological Characteristics as Determinants of Outcome for Spinal Cord Stimulation therapy

Elizabeth Sparkes, MSc

Faculty of Health
Birmingham City University
Birmingham, UK

Spinal cord stimulation (SCS) has been used for the treatment of a variety of chronic pain conditions. Despite robust benefits for some patients, others do not achieve marked analgesia over time, effects that may be due in part to psychological characteristics of the patients. Guidelines from the European Federation of the International Association for the Study of Pain stress the importance of evaluating psychological characteristics of patients prior to implantation. No guidance is provided, however, on specific tests that should be used in such an evaluation. Sparkes and colleagues have carried out a review of the literature to investigate the influence of psychological factors on the efficacy of SCS. These data may be useful in identifying psychological characteristics that can help predict SCS outcomes and guide screening procedures. The review revealed that the Minnesota Multiphasic Personality Inventory Questionnaires 1 and 2 were the most commonly utilized evaluation instruments in the identified studies. Further, depression negatively affected the efficacy of SCS in many studies, although successful SCS improved depressive symptoms in two studies. Conflicting data exist on the effects of hypochondriasis, hysteria, and mania. These results highlight the potential effects of psychological factors on the efficacy of SCS and the need for further long-term studies.

References

1) Sparkes E, Raphael JH, Duarte RV, et al. A systematic literature review of psychological characteristics as determinants of outcome for spinal cord stimulation therapy. Pain. 2010;150(2):284-289.
2) Jamison RN, Washington TA, Fanciullo GJ, et al. Do implantable devices improve mood? Comparisons of chronic pain patients with or without an implantable device. Neuromodulation. 2008;11:260-266.
3) Ackroyd R, Bush DJ, Graves J, McVey J, Horton S. Survey of assessment criteria prior to implantation of spinal cord stimulators in United Kingdom pain management centres. Eur J Pain. 2005;9:57-60.

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