{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:37:57Z","timestamp":1787017077244,"version":"build-2736575974"},"reference-count":39,"publisher":"BMJ","funder":[{"DOI":"10.13039\/100007312","name":"Cleveland Clinic Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007312","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2026,5,13]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether psychological variables independently predict spinal cord stimulation success or instead moderate pain-response dynamics over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort included 217 patients undergoing SCS implantation, with available follow-up in 153 at 6 months and 155 at 12 months. Treatment success was defined as a \u226530% reduction in Numeric Rating Scale (NRS) pain from baseline. Baseline psychological measures included Beck Depression Inventory (BDI) categories (Minimal\/Mild\/Moderate\/Severe), Pain Disability Index (PDI) categories (Low\/High), and 10 binary Personality Assessment Inventory (PAI) traits. Descriptive analyses, Firth-penalized logistic regression, linear interaction models, partial Spearman correlations, and multivariable linear regression were performed using complete-case data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Available-case success rates were 38.6% at 6 months (59\/153) and 30.3% at 12 months (47\/155). At 6 months, baseline NRS was borderline associated with categorical success (OR 1.39, 95%\u2009CI 0.99 to 2.01; p=0.056); BDI, PDI, and PAI traits were not significant. In the 12-month model, most psychological variables were not independently associated with success, although one personality trait \u2018denial of depression\u2019 showed a trend toward lower odds of success (OR 0.34, 95%\u2009CI 0.09 to 1.11; p=0.074), and age showed a borderline association (p=0.056). In the linear models, the relationship between baseline and follow-up pain appeared strongest in the minimal BDI group and weaker in higher BDI categories. The overall model including these depression-by-pain terms was statistically significant (p=0.005, R\u00b2=0.145), though the individual interaction terms did not reach significance. Partial Spearman analysis showed an inverse association between BDI and \u0394NRS at 6 months (\u03c1=\u22120.199; p=0.023; n=133), but not at 12 months (\u03c1=\u22120.060; p=0.493; n=137). Perfectionism and resistance-to-change were associated with smaller 12-month improvement in unadjusted analyses (p=0.0177\u2009and p=0.0378) and remained significant in multivariable modeling (\u03b2 = \u22121.195, p=0.010; \u03b2 = \u22121.101, p=0.009; R\n                      <jats:sup>2<\/jats:sup>\n                      =0.077; p=0.0025).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Psychological measures were not strong independent predictors of binary SCS success. Instead, depressive burden influenced early pain-response coupling, while cognitive-rigidity traits were associated with smaller long-term improvement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-107329","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T17:15:11Z","timestamp":1780506911000},"page":"rapm-2025-107329","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Do psychological assessment tools predict spinal cord stimulation treatment outcomes?"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4601-1434","authenticated-orcid":false,"given":"Mina","family":"Botros","sequence":"first","affiliation":[{"name":"Evidence-Based Pain Management, Cleveland Clinic, Cleveland, Ohio, 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