Evaluation of a mental health screening tool to determine the need for psychological interview for patients offered neuromodulation implant therapies for pain

Maggie Z X Xiao; Kathryn Curtis; Abigail Muere; Hemkumar Pushparaj; Victoria Bains; Yasmine Hoydonckx; Pranab Kumar; Ehtesham Baig; Abeer Alomari; Ryan S D'Souza; Anuj Bhatia

doi:10.1136/rapm-2025-107507

Evaluation of a mental health screening tool to determine the need for psychological interview for patients offered neuromodulation implant therapies for pain

Reg Anesth Pain Med. 2026 Mar 4:rapm-2025-107507. doi: 10.1136/rapm-2025-107507. Online ahead of print.

Authors

Maggie Z X Xiao¹, Kathryn Curtis^{2

3

4

5}, Abigail Muere^{2

3

4

5}, Hemkumar Pushparaj⁶, Victoria Bains^{2

3

4

5}, Yasmine Hoydonckx^{7

8}, Pranab Kumar^{2

3

4

5

9}, Ehtesham Baig^{2

3

4

5

9}, Abeer Alomari^{2

3

4

9}, Ryan S D'Souza¹⁰, Anuj Bhatia^{11

3

4

5

9

12}

Affiliations

¹ University of Toronto - St George Campus, Toronto, Ontario, Canada.
² Department of Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada.
³ Comprehensive Integrated Pain Program, Toronto Western Hospital, Toronto, Ontario, Canada.
⁴ University Health Network, Toronto, Ontario, Canada.
⁵ Neuromodulation for Pain Program, Comprehensive Integrated Pain Program - Interventional Pain Services, Toronto Western Hospital, Toronto, Ontario, Canada.
⁶ Pain Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK.
⁷ Anesthesia and Pain Management, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada.
⁸ Department of Anesthesiology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, UK.
⁹ Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Department of Anesthesia and Pain Management, Toronto Western Hospital, Toronto, Ontario, Canada anuj.bhatia@uhn.ca.
¹² Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.

PMID: 41781150
DOI: 10.1136/rapm-2025-107507

Abstract

Introduction: 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).

Methods: 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 ≥30% pain reduction from baseline.

Results: Of 171 patients (114 AP, 57 FT), trial-to-implant rates were similar (72% AP vs 70% FT, p=0.811). The proportion of responders at 1 year post implant was also comparable (53% AP vs 60% FT, p=0.927). Multivariate logistic regression identified that higher baseline pain intensity (adjusted OR (aOR) 0.70, 95% CI 0.53 to 0.92, p=0.011) and use of tricyclic antidepressants (aOR 0.15, 95% CI 0.04 to 0.56, p=0.005) were associated with implant failure, whereas pain duration >10 years was associated with implant success (aOR 3.09, 95% CI 1.06 to 9.02, p=0.039).

Conclusions: This screening tool effectively identifies patients who can bypass routine psychological assessment without compromising 1 year SCS outcomes. Implementation can streamline patient flow, reduce wait times, and reserve psychological resources for those who need formal evaluation.

Keywords: CHRONIC PAIN; Neuromodulation; Pain Management; Spinal Cord Stimulation.