Personality and Psychopathology as Predictors of Outcome Following Implantation with a Pain Management Device

Abstract

Chronic pain affects millions of individuals and has many life alerting implications. Once pain becomes intractable, patients can often exhaust most conservative treatment options. Current changes in medical technologies have evolved to include treatment with implantable pain management devices and have since become the standard of care. Given the nature of these devices, the need for high levels of compliance with these devices, and post-operative lifestyle changes, the role of the psychologist has become increasingly more important in the patient selection process. Pre-surgical psychological evaluations are used in a variety of medical specialties to aid physicians when determining candidacy for surgeries. It has been well documented that psychological and social factors have been associated with surgical outcome in a variety of surgical procedures. Research investigating the key psychological variables associated with outcome following implantation with a pain management device is limited. As such, the aim of this study is to investigate the role of several psychological variables on surgical outcome post implantation with a pain management device; notability differentiating between Axis I disorders, such as depression and anxiety, and features associated with Axis II personality disorders. The goal is to delineate more specifically the psychological factors which contribute to outcome in implanted pain management therapy. Preliminary analyses suggest no relationship between age, gender, BMI, tobacco use, and PAI T-scores on anxiety, depression, borderline, antisocial, paranoia, and grandiose scales when using a broad good/poor outcome variable. Additional analyses with a more refined outcome variable did find a significant relationship between younger age and good outcome. Post-hoc analyses suggest a relationship between participants' scores on the Oswestry Disability Index, employment status, and the treatment rejection scale on the PAI. Psychologists' clinical judgment was also found to be related to outcome. Discussion includes an exploration into participant's self-perception and functional status and the idea of the help rejecting complainer character style. Study limitations and clinical implantations based on the current findings are discussed.