[aussiemom]

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?

[Lisa in Ohio]

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.

[Mark56]

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,
Mark56Z

[Rrae]

Hey gang.....

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 $$


Rae

[aussiemom]

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.

[Rrae]

Just wanted to send a (((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

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

[Mark56]

Just wish these big old arms were big enough to reach around the world to do a group hug right now.
Yeah, those are HARD HARD things to let loose of, and we all have something we can no longer do, so we do understand.
Prayerfully,
Mark56ZZ

[pain_doctor]

Originally Posted by aussiemom

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?

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.

[Saffy]

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

[Rrae]

Originally Posted by pain_doctor

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.

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.

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