Pain Management/back

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QUESTION: Hello,  I'm  a 58 year old male.  I had a five level fusion with drilling on the left and right of my lumbar region.  It was to free up nerve roots.  I've done physical therapy four spinal injections and pills. Nothing helps.  My pain management Dr. Now wants to try Neuro stimulation. Four tests were sent to me by a psychologist.  He said if I show signs of depression or anxiety etc. He won't ok me for this last resort surgery to releave my six year long spinal pain.  I'm  scared I'll fail because I am depressed and anxious.  What happens to me if I fail this psychological test.  Will they stop the surgery.  I can't imagine myself living with this type of pain any longer.  What can I do if I fail this test. Steven

ANSWER: Steven,
I completely understand your anxiety over this, and to be honest I have never heard of the requirements of psychological testing or screening prior to using this method for pain control. It would make sense, as you said, that you are already anxious and having some depressive symptoms since you have chronic and intractable pain. Instead of just repeating what I have read about the subject, I am including a link which you can go to which should explain to you what they are looking for when they test you. To be honest, it didn't make perfect sense to me either, but then I'm not a doctor, psychologist or anesthesiologist; (these are the doctors who actually perform the neuro stimulation procedure). So, if you will carefully read over this link, as I have, I am hoping it will help you understand why psychological testing is employed. If, after reading this, you still have questions, feel free to write back to me. I will delve further into the subject, because I understand how you might be intimidated by this. As you said, all patients in pain are anxious with some component of depression. It is virtually impossible to mask this. From what I read, it appears that the testing is to rule out severe psychiatric illnesses such as schizophrenia, paranoia, even bipolar disease. Patients with these conditions may not respond well to the neuro stimulation. However, since I've never heard of this being used before, it is new to me, and I am curious as to why they require these tests. So, go to this link. It is written in response to a physician's question, so it is direct with some medical lingo. Let me know if I can help you further. Thanks for bringing this to my attention, because it allows me to become more aware and educated, so therefore I can help other patients in your position. Go to the link, below. Read it through and hopefully it will help you. Let me know if you need more guidance. I'll do what I can.



CLICK or go here:  http://www.painmedicinenews.com/ViewArticle.aspx?d=PRN&d_id=86&i=June+2013&i_id=

---------- FOLLOW-UP ----------

QUESTION: Hello, Thank you for your concern.  I contacted the psychologist.  I've a little more information.  The test he wants to administer is called the m.m.p.I. R 2.  Or close to that. He said it's a spin off of the m.m.p.I. and it evaluates pain and other issues.  Would you find out as much information on the m.m.p.I. r 2 as you can and tell me what questions are on it.  Maybe you could send me a copy of this test. Thanks Steven 8/14

Answer
Follow Up:
Steven,
I am glad I was a little helpful. I am vaguely familiar with the MMPI and MMPI-2. It stands for Minnesota Multiphasic Personality Inventory. I do not know the difference between 1 and 2, and as much as I'd like to, I cannot obtain a copy of one. They are VERY lengthy, and the questions are very difficult to analyze. Your instructions are to answer as honestly as possible, and with some questions they may appear as "trick" questions, you are told to answer what your first thought is. I worked for a psychologist one summer typing up the results of these MMPIs. Just the results were 4-6 pages in length. The MMPI itself is in the form of a booklet, probably 15 or more pages in length, if memory serves. It takes people hours to complete, and my best advice is to do a few pages, then take several hours of a break, then return to it. It is tempting to just go down the line and start making answers arbitrarily so you'll get finished. I think in YOUR case the doctors are looking for signs of how your pain is affecting you emotionally or psychologically. I think there is a trend in ordering these for certain pain patients, but since it is costly, unless insurance covers it as part of your treatment, it seems a waste of YOUR money or resources to me. These tests are very intensive, long, detailed, and have questions that appear, on the surface, to be simple, but they are not. I have typed up reports of patients who tried to make a good impression, but even that was picked up on by the tests! I realize what I'm telling you is scary, and I don't want you to be afraid. I'm just being honest with you. Since the MMPI is very lengthy it is very probable that they will allow you to take it home and return it within a few days. Just follow my suggestions, and answer as honestly as possible. Take long breaks between sessions, because all the testing can become tiring. I am sending you a link to a website where you can read more about these tests. I hope, for your sake, that the MMPI-2 is shorter and more cost-effective. I have not typed these reports in almost 10 years, so I am not at all familiar with the MMPI-2. I would welcome your getting back to me after you test and letting me know what you think of the test. I do wish you luck. Please try to not be nervous. Of course, the test allows for anxiety. But don't let this ridiculous test intimidate you unnecessarily. If you are on pain medication try to take the test before you use your pain meds or any other medications that might interfere with your judgment or thinking. Wish I could offer more helpful suggestions. Below is the link you can click on to learn more. Actually, I was able to find an example of the first 75 questions. This will give you an idea of the inanity of the testing. I included two web links. Hope they help!

CLICK or go:   https://antipolygraph.org/cgi-bin/forums/YaBB.pl?num=1109032158

Here's another site; CLICK or go to:  http://en.wikipedia.org/wiki/Minnesota_Multiphasic_Personality_Inventory  

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Patricia M

Expertise

I welcome questions from people who may want a "nurse's perspective" on the subject of chronic pain and pain management. I am a nurse, NOT a physician (MD).I can answer questions on medications, alternative approaches, and the various organs and body systems. There are many avenues to explore with chronic pain. I am against seeing patients suffer simply because healthcare professionals might suspect they are "drug seekers". There are methods of identifying true pain, and this makes patients feel as if they are taken seriously, which they should be.

Experience

Over 25 years working experience in Internal Medicine, Adult Cardiology, Post-Surgery care, Cancer, psychiatry and some experience as a lay-counselor in addictive medicine (dependence to alcohol and/or drugs, both legal and illegal drugs).

Organizations
I am an Expert with AllExperts in several areas: Pharmacy, Internal Medicine, Medical Errors. Feel free to check my Q&A history as well as my ratings, which are very high.

Education/Credentials
Diploma from hospital-based nursing school. Additional courses in pharmacology. I keep current in continuing education. Am currently working as lay-counselor which can lead to my certification as Substance Abuse Counselor.

Awards and Honors
Dean's List while in college.

Past/Present Clients
Internal medicine patients, cardiology patients recovering from heart disease and/or open-heart surgery, cancer, as well as recently working as a lay-counselor to individuals dealing with addiction to drugs and/or alcohol. NOTE: Just because I attempt to help patients with addictive diseases, I have over 25 years in Internal Medicine, have nursed patients with great deal of pain, and I am compassionate. I never label anyone as a "drug seeker". I have seen that done for years, and am against it. All patients should be evaluated for pain in a fair and comprehensive manner. Am an Expert with AllExperts in three other medical categories; feel free to check my ratings, which are high.

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