Bio-psycho-social assessment of neuromodulation analgesic treatment in patients with failed back surgery syndrome (part two)
Abstract
Introduction: The term "failed back surgery syndrome" (FBSS) refers to patients who continue to experience persistent back pain or pain irradiating to the leg following surgery of the lumbar spine. Most of these patients are affected and weakened in the long-term, they are unable to return to work, they suffer from complex psycho-social problems and often require high doses of analgesics with inadequate results.
The psychiatrist and especially the psychologist prepare indicated patients for neuromodulation and continue to care for these patients following the implantation of the neuromodulation device. Several psychological tests are used for the best selection and preparation of patients for this treatment.
Our article presents the results of the psychological questionnaires that we selected to verify the results of neuromodulation therapy in our group of patients. We also summarize our experience with the weaning of patients treated with neuromodulation from strong opioids.
Methods: Thirty six selected FBSS patients who had failed to respond to conventional medical treatment and who met all conditions, including a successful trial period received neuromodulation analgesic treatment. The detailed evaluation of treatment was conducted with the aid of the self-report symptom inventory (SCL-90) questionnaire.
We focused on patient satisfaction with the neuromodulation treatment, with the aid of an original questionnaire. We used the paired-samples test other statistical methods for our statistical evaluation.
Results: We found that our patients registered an improvement in most items of the SCL questionnaire, of which three items were statistically significant. In the original questionnaire, we recorded an improvement in seven items that describe patient satisfaction with neuromodulation treatment, especially those items dealing with their willingness to repeat this treatment, and to recommend this treatment to other FBSS patients.
Very good results were also recorded in the issue of weaning from strong opioids. All our patients were off such drugs within 10 months of this treatment.
Conclusions: FBSS is currently the most frequent indication for neuromodulation treatment. In concurrence with other studies, we observed high patient satisfaction with this treatment and a significant decrease in the need for strong opioids following neuromodulation therapy.
According to our experience, psychological evaluation is one of the most important factors for the preparation and selection of patients for this treatment as well as for the subsequent evaluation of treatment efficacy.