(318) Case Study of a Psychologically Complex VA Spinal Cord Stimulator Recipient: A Multi-Component Intervention and Significant Change on Repeated Psychological Measures

Abstract

Patients in the Veterans Healthcare Administration system are known to have more physical and psychological morbidities than civilian age and gender matched controls. Relatedly, psychological disorders are known in the Spinal Cord Stimulator (SCS) literature to be a factor negatively affecting efficacy of the SCS device in recipients. This patient had an extensive history of multiple psychological morbidities but had successfully completed a CBT-based pain management and coping skills group and maintained a productive relationship with their psychiatrist for 10 years. Thus, the patient demonstrated themselves capable of positive change over time, which may be a prognostic indicator of SCS success if that psychological stability can be maintained. As part of an ongoing Veterans Affairs Quality Improvement (VAQI) Project, psychological measures of Depression, as measured by the Patient Health Questionnaire (PHQ-9); Catastrophizing, as measured by the Pain Catastrophizing Scale (PCS); and PTSD symptoms as measured by the Posttraumatic Stress Disorder Checklist (PCL 5) were administered to patients considered candidates for Spinal Cord Stimulator placement at initial evaluation. Those measures were repeated with recipients after device implantation at 1 and 6 month follow ups. Measure scores were converted to z-scores to be able to compare results across measures. Time between measure administration was the Independent Variable and represented the effect of the Spinal Cord Stimulator implant. Results indicated significant differences in the desired direction between baseline and six months for the PHQ-9 and the PCS; baseline and both one month and six months on the PCL5. Data collection is currently underway with additional patients advancing to the SCS trial and permanent implant stage. The PROMIS Function, Pain Interference, and World Health Organization Quality of Life (WHOQOL) measures have been added to further identify factors responsive to psychological intervention prior to SCS implantation and prognostic potential for SCS efficacy.