Browsing by Subject "Infusion Pumps, Implantable"
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Item Pre-Surgical Behavioral Medicine Evaluation (PBME) for Implantable Devices for Pain Management : a One-Year Prospective Study(2006-08-11) Heckler, David Robert; Stowell, Anna W.Chronic pain affects millions of individuals around the world financially, physically, psychologically, and socially. When nonoperative care does not provide adequate pain relief, surgically invasive procedures are often considered. However, poor surgical outcome affect the patient, the physician, the employer, and the insurance company. In order to reduce negative surgical outcomes, pre-surgical psychological evaluations are used in order to better predict prognosis. The current study looked at the utility of the Presurgical Behavioral Medicine Evaluation (PBME) and revised algorithm that was described in Shocket's (2005) investigation that determines a patient's prognosis for invasive pain procedures. Patients were placed in a Green, Yellow I, Yellow II, or Red prognosis group, with Green having the best prognosis for surgery and Red having the worst prognosis. A total of 95 patients completed the PBME evaluation, with most patients being evaluated for a spinal cord stimulator or intrathecal pump. Variables, including gender, disability payment status, and involvement in pending litigation, were found to be significantly different among the groups. Analysis of data at the initial evaluation indicated that patients within the Red group endorsed significantly more physical/functional limitations, depressive symptomatology, and reported more psychological distress than the Green group. Patients were followed-up 6- and 12-months post-evaluation with both physical/functional and psychosocial measures. Analysis of the 12-month follow-up data indicated that there were significant differences among the four groups in terms of the VAS, BDI, MCS, OSW scores, and the catastrophizing scale on the CSQ. In addition, the Tukey HSD and Mann Whitney tests revealed specific significant differences among the groups. A repeated measures analysis of the initial evaluation, 6-month, and 12-month follow-up data revealed the Green and Red group was significantly different in terms of the VAS, OSW, BDI, and MCS. In addition, nonparametric analysis indicated that there were significant differences among the groups on total risk factor scores as determined by the PBME algorithm.Item Presurgical Behavioral Medicine Evaluation for Implantable Devices for Pain Management: Clinical Effectiveness for Predicting Outcomes(2005-08-11) Schocket, Kimberly Gardner; Stowell, Anna WrightThe current study attempts to apply a presurgical psychological screening algorithm to a subset of patients being considered to receive implantable pain management devices, specifically spinal cord stimulators and intrathecal drug delivery systems. The Presurgical Behavioral Medicine Evaluation (PBME) algorithm was designed to evaluate patients prior to spine surgery. The algorithm showed strong outcome predictability in previous studies (Block et al., 2003). A PBME was administered to 60 patients being evaluated for implantable devices at a major pain center that provides interdisciplinary pain management to patients. Patients were classified into one of five prognostic categories including Green, Yellow-I, Yellow-II, Red-I, and Red-II. This study sought to elucidate the characteristics of patients falling into the separate prognostic categories. Analyses revealed that males were more likely than females to fall in the Green and Yellow-I groups and patients receiving disability were more commonly found in the Red and Yellow-II groups. The biopsychosocial profiles of each category were examined using various physical/functional and psychosocial measures. As hypothesized, the Green group, with the lowest mean scores for each measure, yielded the most positive biopsychosocial profile at initial evaluation. The Green group reported low levels of depression and little impairment in physical functioning. The Red group obtained the highest mean scores, indicating decreased biopsychosocial functioning at initial evaluation. More specifically, the Red group experienced more depressive symptomatology and decreased physical functioning at the time of the initial evaluation. Additionally, the Red group had a greater number of medical risk factors and the presence of adverse clinical features at onset, and was more likely to use catastrophizing as a coping strategy. The patients were also compared at follow-up showing improvements on most physical/functional and psychosocial measures. Lastly, regression analyses were conducted to elucidate those factors most predictive of prognostic assignments. Thus, the algorithm was able to correctly classify those patients who were and were not appropriate candidates for surgery by collecting and analyzing data with regard to the overall biopsychosocial functioning of patients.