Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression


candidateCandidate: “When it became mandated that all patients seeking implant trial (whether pump or stimulator) be psychologically evaluated, I was pleased yet surprised.

Pleased that there was an awareness that each patient has different psychological capacity to tolerate an implant trial. And I was surprised that anyone noticed that this was true.

Between the pain and the procedure exists the patient. While the pain may be explained, and the procedure understood, the patient can constitute a great unknown.

By far, the most psychodiagnostic common outcome prior to an implant trial is that the patient has no co-existing mental disorder that would preclude his/her candidacy and that the patient is a fully informed, motivated and likely a good candidate.

However, here are some important exceptions:

  1. The pain management practice seeking authorization for the trial may have attempted to bypass the psychological examination in the past by administering a brief psychological test and is now referring the patient after having been been admonished by the insurer.
  2. The pain management practice seeking authorization for the trial has the patient him/herself schedule the psychological appointment
  3. The patient then fails to show for the appointment, never having emotionally commited at the time of making the call
  4. The patient arrives and is bewildered as to why s/he should consider the procedure which s/he does not understand
  5. The patient complies with the psychological evaluation requirement but makes it clear, during the evaluation, that s/he is not even remotely willing to consider implantation
  6. Although the patient is a reasonable candidate for implantation, there are co-existing factors, financial and social, which will complicate complying with the initial trial.
  7. The patient is a reasonable candidate but has family and friends who are discouraging the procedure.
  8. Although there are educational DVDs available from implant manufacturers, this audio-video material is either not provided to the patient or is not reviewed by the patient.

The true gap that exists is between the doctor and the patient, the former wanting to perform the procedure and the latter…just not so sure.


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