{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T09:46:12Z","timestamp":1793353572466,"version":"4.5.0"},"reference-count":32,"publisher":"BMJ","funder":[{"name":"Internal funding from the Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2026,2,16]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Psychological comorbidities can negatively impact outcomes of spinal cord stimulation (SCS) for chronic pain. While psychological assessment is commonly required before SCS implantation, evidence supporting its impact on outcomes is limited, and such assessments may be unnecessary for many patients and contribute to delays in care. Our center implemented a screening tool incorporating validated questionnaires and a mental health checklist to triage the need for formal psychological evaluation. This prospective, observational cohort study compared outcomes of SCS trials and implants between patients who bypassed (fast track: FT) versus those who underwent a formal assessment by a psychologist (AP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data were collected from patients undergoing SCS trials between July 2017 and December 2021. The screening tool used thresholds on validated questionnaires assessing anxiety, depression, catastrophizing, and opioid misuse risk, along with a checklist capturing significant anxiety or depression, self-harm, substance abuse, or mental-health-related hospitalization. Patients screening positive underwent an AP; others proceeded directly to trial (FT). 1 year post implantation outcomes were collected, with successful implantation defined as \u226530%\u2009pain reduction from baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 171 patients (114 AP, 57\u2009FT), trial-to-implant rates were similar (72% AP vs 70%\u2009FT, p=0.811). The proportion of responders at 1\u2009year post implant was also comparable (53% AP vs 60%\u2009FT, p=0.927). Multivariate logistic regression identified that higher baseline pain intensity (adjusted OR (aOR) 0.70, 95%\u2009CI 0.53 to 0.92, p=0.011) and use of tricyclic antidepressants (aOR 0.15, 95%\u2009CI 0.04 to 0.56, p=0.005) were associated with implant failure, whereas pain duration &gt;10 years was associated with implant success (aOR 3.09, 95%\u2009CI 1.06 to 9.02, p=0.039).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This screening tool effectively identifies patients who can bypass routine psychological assessment without compromising 1\u2009year SCS outcomes. Implementation can streamline patient flow, reduce wait times, and reserve psychological resources for those who need formal evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-107507","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T13:45:43Z","timestamp":1772631943000},"page":"rapm-2025-107507","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluation of a mental health screening tool to determine the need for psychological interview for patients offered neuromodulation implant therapies for pain"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7534-6079","authenticated-orcid":false,"given":"Maggie Z X","family":"Xiao","sequence":"first","affiliation":[{"name":"University of Toronto - St George Campus, Toronto, Ontario, 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