The effects of psychological factors on efficacy of Spinal Cord Stimulation

Sparkes, Elizabeth Emma Grace (2013) The effects of psychological factors on efficacy of Spinal Cord Stimulation. Doctoral thesis, Birmingham City University.

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Abstract

Spinal cord stimulation (SCS) appears to be an effective treatment for neuropathic pains, but long-term benefit of more than one year is only found in a proportion of patients treated. This thesis hypothesised that psychological factors may be important as determinants of outcome.

A literature review in this field, whilst demonstrating lack of reliable psychological predictors of SCS treatment, suggested that those thought to be predictive such as depression were more complex. Whilst depression was associated with lower efficacy of treatment by SCS, the treatment itself improved depression. Therefore, depression should not necessarily be seen as a contra indicator, especially when pain and depression interact.

A prospective study with one year follow up of patients implanted with spinal cord stimulator was conducted. Forty patients were included in the final analysis. Functional pain and psychological measures were recorded at six and 12 months, psychological predictors were not significant at six months but significant predictors were found at 12 months. Greater catastrophising, paired with greater anxiety and less perceived control were associated with a < 30 % reduction in pain.

A qualitative study of the experience of SCS using semi-structured interviews one year following SCS implantation revealed similar findings. Thirteen patients reported coping, lack of control and helplessness as impacting upon pain experience. A demand for clearer information systems was discussed in relation to SCS preparation. Information is needed to reduce unexpected experiences including potentially painful trial and body image concerns related to the implantable SCS device. Implications for practice included preparation with expert patients and a tailored preparatory CBT course.

The findings from the two studies demonstrate the necessity to improve the preparation process for patients prior to SCS. Results from both studies conclude that perception of control over pain is important for SCS efficacy and support with anxiety and catastrophic thoughts and behaviours may be advantageous. The predictive equation generated from this study needs to be tested prospectively on further cohorts of SCS patients in order to test reliability. In addition, evaluation of the impact of a tailored CBT course upon outcome needs investigation.

Item Type: Thesis (Doctoral)
Subjects: B700 Nursing
B900 Others in Subjects allied to Medicine
Divisions: Faculty of Health, Education and Life Sciences > Centre for Social Care, Health and Related Research (C-SHARR) > Family Health
Faculty of Health, Education and Life Sciences > Centre for Social Care, Health and Related Research (C-SHARR) > Health Sciences
Faculty of Health, Education and Life Sciences > Centre for Social Care, Health and Related Research (C-SHARR) > Health and Wellbeing
Faculty of Health, Education and Life Sciences > Centre for Social Care, Health and Related Research (C-SHARR) > Quality of Care
UoA Collections > PhD Theses Collection
Depositing User: Mr Richard Birley
Date Deposited: 24 Jul 2017 13:47
Last Modified: 24 Jul 2017 13:47
URI: http://www.open-access.bcu.ac.uk/id/eprint/4921

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