![]() ![]() Thus, wide knowledge gaps exist between their clinical efficacy and MOA. While P-SCS has been heavily examined since its inception, PF-SCS paradigms have recently been clinically approved with the support of limited preclinical research. In this review, we reconstruct the available basic science and clinical literature that offers support for mechanisms of both paresthesia spinal cord stimulation (P-SCS) and paresthesia-free spinal cord stimulation (PF-SCS). While compelling evidence for safety and efficacy exists in support of these novel paradigms, our understanding of their mechanisms of action (MOA) dramatically lags behind clinical data. The rapid clinical implementation of novel SCS methods including burst, high frequency and dorsal root ganglion SCS has provided the clinician with multiple options to treat refractory chronic pain. Despite advances in our understanding of SCS-mediated antinociception, there still exists limited evidence clarifying the pathways recruited when patterned electric pulses are applied to the epidural space. Chronic pain is a widely heterogenous syndrome with regard to both pathophysiology and the resultant phenotype. Instead, complementary and holistic interventions such as mindfulness, cognitive-behavioral therapy, or biofeedback may be a more effective option for pain management.Well-established in the field of bioelectronic medicine, Spinal Cord Stimulation (SCS) offers an implantable, non-pharmacologic treatment for patients with intractable chronic pain conditions. Those who are experiencing hallucinations, delusions, and cannot understand and follow post-operational directions should not have a stimulator. ![]() Q: Are most people cleared to proceed with spinal cord stimulation?:Ī: While most people are cleared to have the trial placement of the stimulator, a small number of people are not. Following the evaluation, the results are shared with you and your physician. See Noninvasive Pain Management Techniques Q: How long is the appointment and can the screening usually be done in a single appointment?Ī: Typically, an evaluation takes two hours and-depending on your insurance-can be done in one appointment. Psychologists can guide people in these therapies as well as provide traditional psychological counseling. Many people find that alternative or complementary treatments, such as biofeedback and mindfulness approaches, can be helpful in helping manage chronic pain. The psychologist can be a valuable member of your pain management team. Q: Can the psychologist make other recommendations besides the stimulator?Ī: Yes. If you are struggling with depression and/or anxiety, the pre-surgical clearance evaluation will offer recommendations to help diminish these feelings. It is typical and expected that people living with chronic pain will have high levels of irritability, anxiety, and depression.Īlso, pain relief often helps decrease depression and anxiety. In fact, chronic pain patients are much more likely to suffer from depression and anxiety than the general public. See Options in Spinal Cord Stimulation Q: What if I am depressed or anxious? Will that stop me from having the stimulator placement?Ī: No. In order for the psychologist to share the information with your surgeon, you will need to sign a release form. The conversation remains confidential between you and your psychologist unless you disclose that you plan to hurt yourself or someone else. You’ll also fill out a few questionnaires about how you manage your pain, your current mood, and your treatment goals. See Who May Benefit from Spinal Cord Stimulation It also involves a social history, family history, information about previous alcohol or substance use, and what kind of psychological treatment you may have had in the past. Typically, the examination consists of a conversation between you and the psychologist about your medical history, including your chronic pain struggles. Knowing what to expect can help decrease worry. Q: What happens during the pre-surgical psychological examination?Ī: Sometimes patients who have never met with a psychologist before get anxious about the initial visit. In part, the pre-surgical clearance examination helps your physician prepare you for the procedure and make recommendations to help you adjust to this new part of your body. Unfortunately, this stress can reduce the effectiveness of the simulator placement. For some, the stimulator can cause an increase in worry and anxiety. Q: Does a referral to a neuropsychologist mean my surgeon thinks I’m crazy or will go crazy after the stimulator placement?Ī: No, but not everyone responds well psychologically when a foreign device is implanted into their body. ![]()
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