Emotional and Physical Pain: The Role of Psychiatric Assessment Before Spinal Cord Stimulation
Seance of wednesday 01 april 2026 (La douleur post-opératoire, Neuromodulation)
DOI number : 10.26299/8ca7-pz41/emem.2026.14.03
Abstract
Chronic pain is a complex condition in which physical and emotional dimensions are closely intertwined. Advances in neuroscience have shown that physical pain and emotional suffering share partially overlapping neural networks, particularly involving the anterior cingulate cortex, insula, and limbic structures. These interactions highlight the importance of considering psychological factors in the evaluation and management of patients with chronic pain, especially when invasive treatments such as spinal cord stimulation (SCS) are being considered.
Preoperative psychiatric assessment has therefore become an important component of patient selection for neuromodulation procedures. The psychiatrist plays a key role in identifying psychological or behavioral “red flags” that may negatively influence postoperative outcomes. These may include untreated major depressive disorder, severe anxiety, maladaptive coping strategies, active substance misuse, unrealistic expectations regarding treatment outcomes, or significant psychosocial instability.
Beyond identifying contraindications or risk factors, psychiatric evaluation also provides an opportunity to propose targeted preoperative interventions. Psychological support, treatment of mood or anxiety disorders, and cognitive-behavioral strategies aimed at improving pain coping mechanisms may enhance the patient’s readiness for neuromodulation therapy.
Integrating psychiatric expertise within a multidisciplinary pain management team allows for a more comprehensive assessment of the biopsychosocial dimensions of chronic pain. Such collaboration helps optimize patient selection, improve postoperative outcomes, and reduce the risk of treatment failure.
Consequently, systematic psychiatric evaluation prior to spinal cord stimulation should be considered a key element in the multidisciplinary management of patients with refractory chronic pain.
Preoperative psychiatric assessment has therefore become an important component of patient selection for neuromodulation procedures. The psychiatrist plays a key role in identifying psychological or behavioral “red flags” that may negatively influence postoperative outcomes. These may include untreated major depressive disorder, severe anxiety, maladaptive coping strategies, active substance misuse, unrealistic expectations regarding treatment outcomes, or significant psychosocial instability.
Beyond identifying contraindications or risk factors, psychiatric evaluation also provides an opportunity to propose targeted preoperative interventions. Psychological support, treatment of mood or anxiety disorders, and cognitive-behavioral strategies aimed at improving pain coping mechanisms may enhance the patient’s readiness for neuromodulation therapy.
Integrating psychiatric expertise within a multidisciplinary pain management team allows for a more comprehensive assessment of the biopsychosocial dimensions of chronic pain. Such collaboration helps optimize patient selection, improve postoperative outcomes, and reduce the risk of treatment failure.
Consequently, systematic psychiatric evaluation prior to spinal cord stimulation should be considered a key element in the multidisciplinary management of patients with refractory chronic pain.