Why psych eval?
 

I've been reading here for months. In some posts people mention a psych eval. Why? I just can't figure that one out. Is it more $$ for ins. co? Do people freak out after they are in?

It is to make sure that you are in a good place to have the SCS implant and that your expectations are not too high. It also explores what your mindset will be if this doesn't work for you in the way you expected. It is standard operating procedure for these devices and your doc will get it set up for you with someone he has worked with in the past.

Hi Barb
 

Now to let you in on what drove me first, The Very First Time, to NeuroTalk, it was questions about the psych eval. I had no clue what to expect, and I like to go into any situation having some preparation. This was the place with the answers.

RRae pulled me aside, well figuratively so, and let me know it was not that big a deal just like Lisa wrote for you a little while ago. I must admit for years prior to the implant I had harbored fear about having the equipment inside me, wondering "Gosh, what if it does not work?!?" Since I had been through SO MUCH surgery by this time, I was leery about more Ginsu Knife work on my back. Back surgery is no picnic. I will forever remember the nights in the hospital after my first fusion and the fellow in the room next door to mine doing the "moan and cry out" all night every night. I should have taken my target range ear protectors.

SO, after having taking every opiate under the sun that the doc could prescribe to me along with boatloads of nerve medications and sleep aids, my physiatrist finally sat my wife and me down and suggested that of all of his patients [and my doc is a VERY conservative, cautious excellent fellowship trained pain doc] he figured I was likely the most perfect example of a patient who presented well for the SCS, what did we think? Cleo, my wife, had been for giving it a go for some time, because she had done stock studies on the manufacturers for her investment club. She was sold. I began to yield because I hated being imprisoned in our bedroom by pain.

Next step, the psych eval. No real explanation was provided except to say that it was a necessary part of the standards of care to confirm my stability pertinent to such a high dollar procedure. Ok. I came here and asked. Then I went.

The psych doc had me to complete a standards based psych eval fill in the bubble test just like taking the ACT back in High School Days. Then he had me come into his office for a personal discussion relevant to my expectations, the pain I was enduring at that time, the impact of the pain upon my life and that of my family, and the like. I was able to speak positively about being level headed regarding an understanding that the procedures do not always turn out to be effective, thus the reason for the two step surgery.... first a Trial for usually a week with wires securely taped to your back where they protrude from insertion at the likely nerve bundle point and trailing down to the waist where the brains of the unit will be mounted in a belt of sorts worn continuously through the Trial.

I was able to share with the psych doc the fact of my family having founded a business manufacturing and selling seating cushions since I had lost my work after the pain causing wreck and that I felt very positive about it.... even showed him one of our units, since I use it, and a brochure. I spoke to him of the continual stable and nurturing support of my family throughout the many surgeries I had endured after the wreck. I talked of my faith and how that is keenly important to my family and to me as we walk this life. Lastly, I shared my participation on this NT site with an intention of developing a blog thread and my dream of being able to wean off of all pain medications if the SCS was eminently successful. It was a congenial conversation. No tension. Nothing hard about it. Then on the way out, he asked if I would share thoughts with another patient he had waiting in the waiting room....... so, I said SURE, and spoke with her for a little while, gave her the NT blog site info and away I went.

The doc wrote a complimentary recommendation regarding my suitability for the procedure. Then I waited while insurance and calendaring was all sorted out for the Trial surgery.

Long story short, it has been a miracle in my life, and I am thrilled with it! Now I am hard at work striving to re-enter my profession and networking like it is an activity more important than breathing! Seriously! So, I feel the upbeat realization of HOPE to regain things lost in my life.

You will do fine! I will pray for you,
Mark56:hug:Z:grouphug:

I bumped our thread back to top
 

Hey gang.....:grouphug:

I bumped up our "Psyche Eval" thread back up to the top
It's FULL of good stuff.

The psyche eval is NOTHING to get alarmed about......it's easy and it's a simple standard procedure required since the SCS is such a very high dollar investment and insurance companies could stand to lose alot of $$

:grouphug:
Rae

Thanks for bumping the other post! Mark, thank you

I've had a 4 level cervical fusion, so there is a bunch of metal there that will never come out. I also have a vena cava filter. None of it bothers me.

As for me, I may not be in the same pain place as some of you, and I don't want to be. I'm debating should I go for surgery and "fix" it, possibly be worse off, and still have problems like I do with the cervical fusions. Or the stim, which seems the lesser of the two. I'm not doing much living now.

I have a 1 1/2 yo Maltese I wanted to train and show. I can't do it. For one thing, she's a far distance down to pet and treat! All that bending, hard to do. It was easier with my Aussie, bigger dog.

I don't seem to handle the pain meds I've tried very well. All of them knock me out of commission for at least 24 hours. No pain, but no me either. He wrote a rx for nucynta, I'm going to give it back to him.

Hi Barb....
 

Just wanted to send a (((Hug))) :hug:
I sure understand how you feel about your special dog(s)......

I am unable to be with my horses and it's unfair to them that they aren't getting the attention they deserve....
I will be finding good homes for a couple of them.....
A couple others will probably just grow 'old' with me :o

But, yeah, :( there is pain, saddness and guilt (in my case)
I try to hang on to the hope that I'll get better and that I'll someday be able to do some of the things I used to do........but sometimes it's just hard to hang on to that hope......

It is amazing, tho, that our pets can and do love us back! My boxer (Sadie) licks the tears off my cheeks when I have my sad 'moments'......
Then she just puts her head against my shoulder and we kinda just sit there holding each other.
And on a couple of occassions, one of my special horses came over to me as I was sitting on a rock weeping.......he came over and just rested his big ol' muzzle on the top of my head.......oh my Lord was that ever a moment to cherish! It was like magic!

I know your dogs mean alot to you......that is something you can never lose - their love and loyalty!!

Caring
Rae
:hug:

I'm there with you both Barb and Rae!!
 

:heartthrob:Just wish these big old arms were big enough to reach around the world to do a group hug right now.:grouphug::grouphug:
Yeah, those are HARD HARD things to let loose of, and we all have something we can no longer do, so we do understand.:heartthrob:
Prayerfully,
Mark56:hug:ZZ

Aussiemom; I show my dogs too...well I did. I haven't been able to since RSD in my left hand/arm. Then I lost all 6 of my dogs and home in a fire last May. I have 2 pups now and since getting my scs a month ago, my goal is to be able to show them. I did agility also and if it kills me I will do it again. I haven't been able to open my hand but am able to hold certain leashes in my hand. My pups don't pull.

I don't think you should give up quite yet. Besides, they do make accomodations for people with dissabilities in the show ring. When I was first diagnosed I could not handle holding a leash in my left hand SO I gaited the dog on my right in the opposite direction after the other dogs had gone around. I did manage to put 7 pts on the dog this way!

Don't give up on the wish to show your dog...just find a way that you can manage. I gave up on saying I can't, now I just say I'll find a way. Yes, I do hurt more after pushing myself but I'm gonna live enjoying life.

Back to the topic; I thought i would have a psych eval before mine but I didn't. I had seen the psych last yr so i don't know if he made recommendations based on then. My Dr suggested this as a last resort but he didn't think it would help me....surprise! It hasn't cured anything but makes things bearable.
patty

My screen handle is Aussiemom, I was. He went to the Bridge Sept 2010, at 14 1/2 yo. We did agility and obdience. I got the Maltese thinking small would be easier. I don't see agility for us. Conformation either, a Maltese in full show coat is a whole lotta work!

Rae, that is so neat with your horse. I always wanted one, didn't happen. Always dogs.

Mark, I'd love a hug, people here would be gentle.

I'm going to get the pup and sleep a while. Nite!

psych eval for big procedures and spine surgery
 

The issues here are beyond belief. MOST folks don't have any problems, but unfortunately certain personalities are attracted to high-tech and invasive procedures because of what might be called "psych issues". These folks, e.g. hypochondriacs, narcissistic persons etc., may not be recognized easily without a formal evaluation. Invariably, they do well on a trial, but will go bad after less than 4 months, and demand some sort of satisfaction, often getting the device removed or wanting immense amounts of medications and weekly visits in clinic. For all concerned, it is best not to court fire by missing this.

I wrote mine out somewhere .. can anyone find it? I can't!

Welcome pain_doctor :)

SO! You're a pain doctor. It's nice to see an actual physician take the time to get on a forum such as this. I (think) this indicates that you care enough about your pts to see what feedback is coming from SCS recipients.

I find your post rather interesting....and a bit difficult to comprehend what it is that you are trying to get across.
It appears to me that you are catagorizing 'These Folk' e.g. hypochondriacs, narcissistic, etc to be the ones who 'Invariably' present with 'problems' and demand some sort of satisfaction.....and wanting immense amounts of meds and weekly visits in clinic.

I think we should rewind a bit here and go back to the initial visits during the 'sales pitch' of these devices. It is repeatedly stressed to the patients that we should NOT expect to get more than 50% pain relief.
THIS ISSUE seems to somehow go by the wayside after the doctor receives his VERY LARGE financial kickback. It is at THIS point (perhaps the 4 months you speak of)"that something may go wrong and they demand some sort of satisfaction.....and wanting immense amounts of meds and weekly visits in clinic" - your words quoted....

Shouldn't it go unspoken that a PAIN PATIENT will be receiving BT meds for the 50% of pain relief that the SCS might not cover?
And WEEKLY visits seem a bit far-fetched......perhaps MONTHLY.
I'm sensing a bit of resentment coming from you, a PAIN doctor. I would think it would be understood from DAY ONE that a PAIN doctor will be prescribing PAIN meds to a PAIN patient.

Are you very familiar with RSD? Neuropathy? I'm thinking yes because a diagnosis must accompany the paperwork in doing the SCS procedure and most patients have conditions such as these. Are you aWARE of what it is like for a patient to have these conditions?
When you signed up to be a PAIN doc, did you not take into account that patients with these horrible chronic conditions WILL be needing 'chronic care' from you?
......hypothetical questions here. You aren't on a witness stand. :o

Some of what you say sort of reminds me of MY pain doc. He takes at least 6 vacations a year. He really doesn't seem to give a HOOT about the ongoing care to the patients he sees for intense chronic pain. He only seems interested in doing the HIGH COST procedures with his BIG needle. And oh yes how he LOVES to do the SCS implants. But guess what? He won't even consider doing pain pumps. Guess why? Because "Then I'd have to 'marry' those patients" (his exact words).

Anyway, it'd be GREAT if you stick around. I'd love to try to understand you further.

Rae

Thanks Rae re pain_doctor
 

It would be fairly easy to read pain_doc's muse from a pejorative perspective, and yet under the standards of care relevant to implant of scs units in chronic pain scenarios, BOTH to discern the patient who may have psychological proclivities toward such procedures out of a sense of attention as tends to be demonstrated by the DSM diagnoses of psychoses, and to discern the patient who may have deep set fear relevant to implant of artificial devices within the body. I have a relative in the generation more senior to me who VERY CLEARLY would present as a patient for whom SCS should not be performed, the psychoses are very nearly written in bold letters on their face. Such tremendously expensive surgery performed for such a patient would readily descend into ultra-dissatisfaction once the pity factor had worn off and the patient realized perhaps a less than perfect outcome.

Perfect outcomes; namely, the situations in which a patient is able to withdraw completely from dependence upon pain management meds is anomalous to the statistical realities of SCS implant scenarios. Truly, the ratio of pain relief nearing achieved success in has been spoken to and written of as a 50% to 75% pain remediation. I am anomalous as one who has fully withdrawn from meds.

One fantastic truth about my scenario from the beginning has been that my physiatrist [aka pain doc] is Board Certified and Fellowship Trained in this specialty. He is readily acknowledged in the local medical community as a careful conservative physician who recommends SCS in a last resort treatment context after having weighed cautiously the patient response to other therapies.

One thing my physiatrist also presents is deep knowledge and experience with patients who both qualify for SCS treatment and their statistical success in post surgical remediation of the pain profile. Unfortunately, some out there do pretend to carry sufficient knowledge or credentials as would qualify them as a field expert who might opine whether a patient is ripe for SCS treatment and the anticipated post surgical result. I encountered one such so called expert in court the other day, who, in his studied professional opinion rendered a negative commentary on my presentation and status despite his admitted complete lack of experience with ANY SCS patient and despite cross examination which yielded his concurrence with my physiatrist upon each and every scintilla of standards conformity of my body condition. This so called expert planted his foot firmly in the way of retroactive disabiltiy payments which would have assisted me and my family.

I cannot but imagine that if this so called expert pain doctor could Overtly Erroneously apply standards to my case, there are others flung across the AMA who for lack of better supervision leap to SCS as a means to treat without adequately weighing a patient need. Rae speaks of these as physicians unduely motivated by profit over care. Surely, this happens from time to time. After my court experience, with a lackey professional expert, surely there are those who profess knowledge to gain profit that is misplaced.

Standards based care which carefully takes a good many steps to fully understand the patient and develop as complete a picture of likelihood of success of a procedure seems most appropriate. I, too, would entertain Pain_Doctor's continued dialogue here as one who may prove to be solidly grounded on the perpetuation of standards based care. So, Pain_Doctor, care to chime in?

Thank you,
Mark56

This was an interesting NPR show on Diane Rehm the other day..I found myself shouting at the radio at times..

http://thedianerehmshow.org/shows/20...on-painkillers

hope you can listen to the podcast...:grouphug: