Psychological considerations in preparing patients for implantation procedures

Abstract

Chronic pain is a multifaceted phenomenon which requires the collaboration of multidisciplinary providers for assessment and treatment. A host of emotional, psychosocial, and behavioral factors have been shown to negatively influence the experience of persistent pain and to increase subjective perceptions of disability. Surgical implantation devices - spinal cord stimulators or implanted medication pumps - are increasingly being used for the treatment of intractable pain, and considerable evidence exists to support the value of presurgical psychological assessment and treatment of those biopsychosocial factors which may adversely impact the acquisition of positive functional outcomes after spine surgery. The empiric support for psychological preparation of patients for spine and pain-related surgeries is reviewed in this article, and specific topics including the providing specialized presurgical psychoeducation, evaluating and shaping appropriate treatment expectations, mood management, encouraging pre- and postsurgical monitoring of outcome measures, instruction in relaxation techniques, and improving sleep hygiene skills will be addressed. Taken collectively, the existing behavioral literature provides considerable support, including psychological assessments and treatments, for patients undergoing surgical pain treatment. © 2006 American Academy of Pain Medicine.