Pre-Surgical Behavioral Medicine Evaluation (PBME) for Implantable Devices for Pain Management : a One-Year Prospective Study
Heckler, David Robert
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Chronic pain affects millions of individuals around the world financially, physically, psychologically, and socially. When nonoperative care does not provide adequate pain relief, surgically invasive procedures are often considered. However, poor surgical outcome affect the patient, the physician, the employer, and the insurance company. In order to reduce negative surgical outcomes, pre-surgical psychological evaluations are used in order to better predict prognosis. The current study looked at the utility of the Presurgical Behavioral Medicine Evaluation (PBME) and revised algorithm that was described in Shocket's (2005) investigation that determines a patient's prognosis for invasive pain procedures. Patients were placed in a Green, Yellow I, Yellow II, or Red prognosis group, with Green having the best prognosis for surgery and Red having the worst prognosis. A total of 95 patients completed the PBME evaluation, with most patients being evaluated for a spinal cord stimulator or intrathecal pump. Variables, including gender, disability payment status, and involvement in pending litigation, were found to be significantly different among the groups. Analysis of data at the initial evaluation indicated that patients within the Red group endorsed significantly more physical/functional limitations, depressive symptomatology, and reported more psychological distress than the Green group. Patients were followed-up 6- and 12-months post-evaluation with both physical/functional and psychosocial measures. Analysis of the 12-month follow-up data indicated that there were significant differences among the four groups in terms of the VAS, BDI, MCS, OSW scores, and the catastrophizing scale on the CSQ. In addition, the Tukey HSD and Mann Whitney tests revealed specific significant differences among the groups. A repeated measures analysis of the initial evaluation, 6-month, and 12-month follow-up data revealed the Green and Red group was significantly different in terms of the VAS, OSW, BDI, and MCS. In addition, nonparametric analysis indicated that there were significant differences among the groups on total risk factor scores as determined by the PBME algorithm.