Why Do I Need a Psychological Evaluation for a Spinal Cord Stimulator?

A spinal cord stimulator is a highly effective treatment option for managing chronic pain.

It’s a solution for many people who have tried other ways to manage their pain but haven’t found success with medications, injections, and surgery. It’s also a great alternative for people who don’t want the side effects of pain medications.

Chronic pain affects a person both physically and emotionally. A psychological evaluation is routinely performed before a spinal cord stimulator trial to determine a person’s suitability for the treatment option.

A psychologist can be a valuable member of your pain management team, and an evaluation is a normal and important step in determining the treatment plan that will work best for you. It’s understandable to have questions or concerns, especially if you’ve never seen a psychologist before.

Below, we’ll discuss why a psychological evaluation is necessary and important before getting a spinal cord stimulator and what to expect during this part of the process.

How does a spinal cord stimulator work?

First, to help understand the psychological aspect, it may be helpful to know how spinal cord stimulation works. Chronic nerve pain is caused by damaged nerves that send pain signals through your spinal cord to your brain. A spinal cord stimulator is a small device implanted in your back or buttocks. It uses gentle pulses to block pain signals from reaching the brain.

This video explains how Nevro HFX spinal cord stimulation works:

What does a psychological evaluation have to do with getting a spinal cord stimulator?

There are certain psychological characteristics that can play a role in whether a spinal cord stimulator successfully reduces a person’s pain. For example, outcomes can be affected by factors such as depression, anxiety, and somatization — when physical symptoms arise from psychological issues.

For example, a person who has just lost a loved one may experience grief through severe fatigue or joint pain. Although there is no underlying physical source, somatic symptoms are very real. Coping skills can also contribute to the outcome of a spinal cord stimulator for different people.

It might interest you to know that getting a spinal cord stimulator isn’t the only procedure where a psychological evaluation is required. It’s a typical part of the process for people undergoing cosmetic and weight loss surgeries, in vitro fertilization, and other procedures, as well. In many cases, a pre-surgical psychological exam is required by insurance providers.

Does a referral for a psychological evaluation mean my surgeon thinks I need help with my mental health?

No, not at all. Again, getting a psychological evaluation before a spinal cord stimulator trial or surgery is routine, and it’s a common requirement for many surgical procedures.

The psychological evaluation helps prepare you mentally and physically for the procedure and helps your doctor make recommendations to help you adjust to having an implanted device. The reason why a psychological exam is part of the spinal cord stimulation process is because everyone responds differently when a device is implanted in their body. Some people may not respond well; it can cause increased worry and anxiety, which can reduce the effectiveness of the device.

The psychologist’s role during the evaluation isn’t to judge you. Instead, the goal is to collect the necessary information for your doctor or insurance provider. It can also help if you’re not sure whether a spinal cord stimulator is right for you.

The psychologist will discuss your goals and expectations, and help you feel 100% confident before you move forward with the trial. If it’s determined that a spinal cord stimulator isn’t the right option for you, the psychologist may offer other treatment suggestions for you to consider based on your specific needs and concerns.

It’s important to understand that a psychological exam is not created to pass or fail you as a candidate. Instead, the results of this evaluation are used to guide your care and ensure success in your pain management journey.

What happens during the psychological evaluation?

The psychological screening process is simple and straightforward. The evaluation generally takes about two hours and can usually be done in one appointment.

Think of your visit as a conversation between you and the psychologist. They will ask about your medical history, your family history, any previous psychological history, and any substance abuse.

The psychologist will ask you about the chronic pain you have been experiencing, how it impacts your day-to-day life, and how the pain has affected you both physically and emotionally.

Typically, you will also be asked to fill out a questionnaire about your current mood, how you manage your pain, and what your pain management goals are.

Your responses will give your pain management team a better understanding of your chronic pain history, your pain levels and tolerance, activities and emotional factors that may be contributing factors, and past and present pain relief methods.

It’s important to know that the conversation you have with your psychologist is confidential. The psychologist will only share your information with your doctor if you provide consent.

Will I not be able to get a spinal cord stimulator if I’m depressed or have anxiety?

No. Experiencing depression and anxiety doesn’t mean you will be disqualified for a spinal cord stimulator. In fact, people who have been living with chronic pain are much more likely to experience depression and anxiety. This is normal and expected.

Past psychological issues also don’t mean you are not a good candidate. Every person is different, and everyone’s situation is assessed individually.

Most people are cleared to have a spinal cord stimulator trial following a psychological evaluation. However, a small number of people are not. For example, people who are experiencing delusions or hallucinations, as well as those who can’t understand and follow post-op directions, are not good candidates.

How do I find a psychologist?  

Your pain management doctor should give you an information packet with a list of psychologists who are experienced in performing pre-surgical evaluations, as well as a letter to give to the psychologist.

Once I am cleared for a spinal cord stimulator, what’s the next step?

Once you have completed your psychological evaluation and been approved as a candidate for a spinal cord stimulator, you will have the opportunity to try it using a temporary external device.

The trial will let you test-drive the device for about a week, evaluate your pain relief, and see if there’s an improvement in your mobility, quality of life, and mood. This will give you a better idea of whether getting the device implanted will effectively reduce your pain.

If you get at least 50% pain relief during your trial, then you’ll have the option to move forward with the implant. Learn more about the process and what to expect.

Your spinal cord stimulator options

Spinal cord stimulators are not all the same. While the treatment is not new, there have been significant advancements in spinal cord stimulation within the last ten years. Nevro HFX, a next-generation approach, has been clinically proven to provide substantially more long-term pain relief compared to traditional spinal cord stimulators.^1-2

HFX is the most advanced spinal cord stimulator available because it offers the following features:

• It’s the only spinal cord stimulator to offer both high-frequency and low-frequency programs. Traditional spinal cord stimulators only offer low-frequency therapy, which has been shown to provide less pain relief. HFX is unique in that it offers high-frequency and low-frequency options for customized relief and the best possible long-term outcome.
• It has the highest long-term success rate for chronic back and leg pain.^1-2 HFX has been clinically proven to provide more and longer-lasting pain relief from chronic back and leg pain than other spinal cord stimulation systems. A major clinical study found that nearly 80% of people experienced significant pain relief with HFX, compared to only 49% of people with a traditional spinal cord stimulator.^1-2
• It gives you more freedom. Traditional spinal cord stimulation cannot be used in certain settings, such as when driving, sleeping, and getting an MRI.^* HFX offers programs without these lifestyle limitations.
• It’s designed for 10+ year battery life without programming restrictions.³ Non-rechargeable traditional spinal cord stimulators require you to use a restrictive set of programs to preserve battery life. This limits your programming options and pain relief. HFX has a rechargeable battery designed to last at least 10 years without any programming restrictions, so all you need to worry about is getting the best pain relief possible.

The data speaks for itself: 77% of people who have tried a traditional spinal cord stimulator rate HFX as a better treatment option. ^4-5 Learn more about the difference between traditional spinal cord stimulation and Nevro HFX.

The next steps

Curious to see if HFX is right for you? The first step is to take a short assessment today. At the end, you can request a call from an HFX Coach who will answer any questions you have and help you find an HFX doctor in your area.

Footnotes:
*Within conditional parameters. Refer to Senza MRI Guidelines for detailed information on MRI safety and conditions.

Sources:
1. Kapural L., et al. Novel 10-kHz High-frequency Therapy Is Superior to Traditional Low-frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain. Anesthesiology, 123(4)
2. Kapural L, et al. Comparison of 10-kHz High-Frequency and Traditional Low-Frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: 24-month. Results from a Multicenter, Randomized, Controlled Pivotal Trial. Neurosurgery. Published 09 2016.
3. Senza Summary of Safety and Effectiveness Data (SSED). Published May 8, 2015.
4. Nevro patient satisfaction survey data. Data on file. Calculated 10/1/2020
5. Tiede et al. Pain Practice, 2006; 6(3): 197-202