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SCS Psychological Contraindications — FRCA Final MCQ

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HardPain MedicineSCS Psychological ContraindicationsFRCA Final

A 50-year-old man (ASA II) with chronic low back pain is assessed for a spinal cord stimulator trial. He has had adequate trials of gabapentin, pregabalin, duloxetine, and amitriptyline. He also completed a pain management programme. His psychological assessment reveals active substance misuse and untreated severe depression with suicidal ideation. Should SCS proceed?

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Correct answer: A — Yes – SCS may improve his depression

Active substance misuse and untreated severe depression with suicidal ideation are relative contraindications to SCS implantation. NICE TA159 and Faculty of Pain Medicine guidance require psychological assessment confirming suitability before SCS. These conditions: predict poor SCS outcomes, increase risk of device misuse/manipulation, complicate informed consent, and the suicidal ideation requires urgent psychiatric treatment independent of the pain condition. Management: urgent psychiatric referral, substance misuse treatment, and reassessment for SCS once these issues are stabilised.

Reference: NICE – 2019 – TA159 Spinal cord stimulation; Faculty of Pain Medicine – 2023 – SCS selection criteria