Coping Skills Training for Spinal Cord Stimulator Patients

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Chronic low back pain (CLBP) is a major source of disability for more than 5 million Americans. Estimates of the economic impact range from $50 to $100 billion annually. The magnitude of psychological distress and disability in these patients is immeasurable. Spinal cord stimulator (SCS) implantation surgery represents an important advance in the treatment of patients suffering from CLBP. SCS implants are becoming increasingly common, with tens of thousands of SCSs implanted annually. Unfortunately, the success rate of SCS implantation varies widely, and most patients will continue to experience some degree of pain following the procedure. Clinical observations suggest that the ability of patients to cope with this pain is quite varied. The proposed study seeks to determine whether a peri-operative pain coping skills training protocol will lead to improvements in pain coping and self-efficacy for pain management and to reductions in physical disability, psychological distress, pain and pain behavior in patients having CLBP who undergo SCS surgery. In this study, 128 patients who are undergoing SCS implant will be randomly assigned to one of three conditions: 1) Pain coping skills training for implant surgery (PCST-IS) which systematically trains patients in a variety of cognitive and behavioral coping skills designed to increase their self-efficacy with regard to their abilities to address specific challenges posed by SCS implant surgery; 2) Chronic pain education a comparison condition providing education on the nature and treatment of chronic low back pain; or, 3) standard care control condition. Assessment measures to be collected before and after treatment and at 6 and 12 months follow-up include measures of self-efficacy, pain coping, physical disability, psychological distress, pain, and pain behavior. If peri-surgical pain coping skills training is effective, it would lay important groundwork for further application and testing of this treatment in other pain-related surgical interventions. An evidence-based psychological intervention could have significant implications for the medical management of spinal cord stimulator patients. It also could lead to a greater integration of psychological interventions into standard medical care for patients undergoing surgery for a number of other painful conditions. As a result, this research ultimately could lead to peri-surgical coping skills interventions that could improve the physical and psychological functioning of patients suffering from a variety of pain-related conditions.