Evaluation of Patients for Implantable Pain Modalities: Medical and Behavioral Assessment

BACKGROUND: Advances in neurobiology serve as the basis for current and evolving implantable pain modalities, consisting of neurostimulation and neuraxial drug administration systems. Appropriate treatment of pain begins with an accurate diagnosis based on thorough physical and behavioral evaluations. MEASURES: The medical evaluation includes a review of the patient's medical history, diagnostic studies, physical examination, complete diagnostic workup, and screening trial of the proposed implantable therapy. The behavioral evaluation includes a review of the patient's history and medical records, clinical interview, mental status examination, psychological testing, and determination of suitability for implantation. CONCLUSIONS: Patients with chronic pain are subject to neurophysiological, emotional, and behavioral influences that govern their perception of pain and of pain relief. Therefore, treatment of chronic pain is multidisciplinary, drawing on cognitive and behavioral psychological therapies, functional rehabilitation, orthopedic and neurologic surgery, medications, nerve blockade, neuroaugmentative procedures, and sometimes neurodestructive procedures. Appropriate selection of patients helps ensure that implantable therapies are used for those who are most likely to benefit.