Protocol Based on Questionnaires and a Mental Health Checklist Can Replace In-Person Psychological Assessment Before Neuromodulation Therapies

According to a 2016 report from the Centers for Disease Control and Prevention (CDC), chronic pain affects an estimated 1 in 5 (50.5 million) US adults. Chronic pain interferes with activities of daily living, is a leading cause of medical care, and is associated with several psychological comorbidities, including substance abuse, depression, and anxiety. For some patients, multiple medications combined with psychological interventions do not provide adequate pain relief. Neuromodulation (NM) therapies, an advancing area of chronic pain management, work by blocking pain signals from reaching the brain and can provide substantial relief in patients for whom conservative therapies have failed. Before NM implantation, candidates commonly undergo an in-person psychological assessment to evaluate the likelihood of treatment outcomes. However, the predictive value of psychological testing is not straightforward, and the process can cause undue delays. Researchers at Toronto Western Hospital in Canada have proposed a protocol that incorporates a short mental health checklist and pre-defined cut-offs on validated questionnaires to assess the need for an in-person assessment by a psychologist.

Maggie Xiao, Fung Ping Wong, Amol Deshpande, Anuj Bhatia, Hemkumar Pushparaj, Kathryn Curtis, Pranab Kumar, and Jamal Kara of Toronto Western Hospital, Toronto, Canada, received a Best of Meeting Abstracts Award from the American Society of Regional Anesthesia and Pain Medicine (ASRA) for its 20th Annual Pain Medicine Meeting, being held November 18-20, 2021. The authors will present Abstract #2292, “Can a Protocol Replace Mandatory Psychological Assessment for Workup of Neuromodulation Therapies for Pain?” on Thursday, November 18.

Patients who screened positive for evident, unresolved psychological conditions underwent an in-person psychological assessment, and patients who screened negative proceeded directly to an NM trial as part of a fast-track group. Of the 171 patients who underwent NM trials for pain at the study center from July 2017 to December 2020, 57 (1 in 3) patients bypassed an in-person psychological assessment. No significant differences in pain reduction outcomes were found between the psychological assessment and fast-track groups. In addition, 72% of patients in the psychological assessment group and 70% of patients in the fast-track group had a successful NM trial. Follow-up data in 110 patients showed 60% in the fast-track group and 53% the psychological assessment had good pain control at 6 to 12 months. 

The results suggest an algorithm incorporating validated psychological questionnaires and a mental health checklist can be used to identify patients who do not need a formal in-person psychological assessment without a negative impact on outcomes of NM therapies for pain. “This can help reduce wait times and optimize the utilization of healthcare resources,” Xiao et al. said.

ASRA is a professional member organization of more than 5,000 physicians and healthcare providers across the United States and the world. The vision of ASRA is to relieve the global burden of pain. ASRA is dedicated to advancing the science and practice of regional anesthesia and pain medicine to improve patient outcomes through research, education, and advocacy. Learn more at