Podcast
Questions and Answers
What is the purpose of the Opioid Risk Tool (ORT)?
What is the purpose of the Opioid Risk Tool (ORT)?
Which risk category does a patient with an ORT score of 5 fall under?
Which risk category does a patient with an ORT score of 5 fall under?
What is one requirement for a risk assessment according to the guidelines?
What is one requirement for a risk assessment according to the guidelines?
Which method is suggested for assessing a patient’s risk of abuse and dependency?
Which method is suggested for assessing a patient’s risk of abuse and dependency?
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What is the main focus of the mental health assessment in this context?
What is the main focus of the mental health assessment in this context?
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What must be documented during the evaluation process?
What must be documented during the evaluation process?
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What conclusion can be drawn from a patient with an ORT score of 0?
What conclusion can be drawn from a patient with an ORT score of 0?
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Which of the following is NOT part of the evaluation and risk assessment process?
Which of the following is NOT part of the evaluation and risk assessment process?
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What is one of the key criteria for patient selection for implantable pain therapies?
What is one of the key criteria for patient selection for implantable pain therapies?
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Which characteristic disqualifies a patient from being a good candidate for spinal cord stimulation?
Which characteristic disqualifies a patient from being a good candidate for spinal cord stimulation?
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Why is psychological evaluation important before spinal cord stimulation implantation?
Why is psychological evaluation important before spinal cord stimulation implantation?
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Which of the following is NOT a potential indication for spinal cord stimulation?
Which of the following is NOT a potential indication for spinal cord stimulation?
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What does a successful screening trial indicate in the context of spinal cord stimulation?
What does a successful screening trial indicate in the context of spinal cord stimulation?
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Which condition can serve as a contraindication to spinal cord stimulation implantation?
Which condition can serve as a contraindication to spinal cord stimulation implantation?
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In assessing patient-specific characteristics for spinal cord stimulation, what psychological issue is a significant consideration?
In assessing patient-specific characteristics for spinal cord stimulation, what psychological issue is a significant consideration?
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What role do psychological characteristics play in the selection of candidates for spinal cord stimulation?
What role do psychological characteristics play in the selection of candidates for spinal cord stimulation?
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What is a common requirement from insurance companies before SCS implantation?
What is a common requirement from insurance companies before SCS implantation?
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Which factor may trigger a psychological consultation before SCS implantation?
Which factor may trigger a psychological consultation before SCS implantation?
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Which of the following is NOT a key question during a psychological evaluation?
Which of the following is NOT a key question during a psychological evaluation?
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What is a significant concern regarding the SCS trial?
What is a significant concern regarding the SCS trial?
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Which personality measure is commonly used in a pre-surgical psychological screen?
Which personality measure is commonly used in a pre-surgical psychological screen?
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Which statement reflects a misconception about surgical expectations?
Which statement reflects a misconception about surgical expectations?
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What factor should be assessed regarding a patient's coping mechanisms?
What factor should be assessed regarding a patient's coping mechanisms?
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Which statement regarding patient risk assessment is correct?
Which statement regarding patient risk assessment is correct?
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Which description applies to patients' expectations for surgery?
Which description applies to patients' expectations for surgery?
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Which emotion-related suspicion may prompt a psychological evaluation?
Which emotion-related suspicion may prompt a psychological evaluation?
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Study Notes
Equipment and Responsibilities
- Psychologists or neurologists may assist in assessing competence for device implantation, especially when there are concerns from the implanting doctor.
Pre-Surgical Psychological Evaluation
- Many insurance companies mandate a psychological evaluation before Spinal Cord Stimulator (SCS) implantation.
- Evaluations are essential when diagnostic tests or symptoms show inconsistencies.
- Emotional instability, personality concerns, and poor coping mechanisms are red flags during screenings.
Key Evaluation Questions
- Assess patient’s desire for the procedure and their pain reduction expectations.
- Discuss the patient's intent to reduce reliance on oral pain medications.
- Evaluate the type and level of social support available for the patient.
Principles of Screening
- Goals of SCS therapy must be collaboratively defined by the physician and patient before trials begin.
- Individualized goals are crucial; uniform objectives may not apply to all patients.
- SCS trials should mimic conditions of long-term use to gauge effectiveness.
Additional Considerations
- Discuss the location of the SCS device and implications for future MRI diagnostics.
- Address common potential issues such as discomfort from movement or changes in lifestyle.
- Establish a plan for patients who decide against the SCS after initiation.
Psychological Assessment Tools
- Utilize personality assessment measures like MMPI-2 RF, MBHI, and MCMI-III as pre-surgical psychological screenings.
Surgical Expectations
- Patients should recognize ambiguity in surgical outcomes; it may not resolve all medical issues.
- Awareness of potential for increased pain post-surgery is essential.
- Acknowledge potential muscle spasms as part of the body's protective mechanism post-surgery.
Risk Assessment
- Conduct comprehensive pre-surgical psychological screening including review of medical history and mental health evaluation.
- Assess risks for abuse and addiction, focusing on untreated psychological issues.
What is SCS?
- SCS consists of four components: implantable pulse generator, lead with electrodes, extension wire, and a hand-held remote for patient use.
Potential Indications for SCS
- SCS may be indicated for conditions like Complex Regional Pain Syndrome, neuropathic pain, failed back surgery syndrome, and refractory angina pectoris.
Candidacy Issues
- Identifying suitable candidates for SCS is pivotal for effective pain management outcomes.
- Psychological characteristics significantly influence the patient's pain experience.
Patient Selection Criteria
- Candidates must have experienced failure of conservative therapies and have no serious drug habituation issues.
- Successful screening trials are necessary with no contraindications to implantation.
Patient-Specific Characteristics
- Prospective patients should not have untreated drug addiction issues.
- Thorough documentation of medical history and diligent review of past medical records is critical.
Risk and Abuse Assessment
- Conduct mental health assessments focusing on addiction risk using peer-reviewed validated methods.
- The Opioid Risk Tool (ORT) helps predict the likelihood of aberrant drug behavior, with scoring indicating low to high risk profiles.
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