For too long, the psychological evaluation, often termed "psych clearance," for chronic pain procedures like Spinal Cord Stimulator (SCS) implantation, has been a required but often undervalued step in patient care. At Nurocoach, we understand the critical need for mental health integration, recognizing that the current model falls short in several key areas.
The existing "psych clearance" model is widely recognized as problematic. It frequently serves as:
Treating chronic pain without adequately addressing psychiatric and behavioral components often leads to:
The healthcare system faces immense pressure from a national mental healthcare shortage, an unprecedented opioid addiction epidemic, and heightened behavioral health needs post-COVID. Many individuals with chronic pain and co-occurring mental health symptoms (like depression and anxiety) do not receive adequate mental health treatment, with research indicating that only 44% of such individuals receive treatment perceived as sufficient. Referral completion rates for outpatient mental health are also very low, often around 10%.
What the Data Reveals:
A comprehensive analysis of 19,129 neuromodulation candidates over a three-year period highlights the prevalence of unaddressed mental health challenges:
In a separate study, high preoperative PHQ-9 scores correlate strongly with post-surgical pain, disability, and narcotics use. This evidence underscores the critical need for a more integrated and proactive approach to mental health in pain management.
Nurocoach is committed to transforming chronic pain management by holistically integrating mental health into your pain practice, moving "Beyond the Psych Clearance". While reducing administrative burdens on your staff.
Our mission is to redefine surgical psychological evaluations by illuminating the roots and impacts of chronic illness, co-creating a truly integrative healing journey for every patient, and acknowledging the profound connection between the mind and body.
Partnering with Nurocoach will improve patient outcomes while also reducing the amount of care coordination invested in some of your most challenging patients– specifically, high catastrophizers, untreated depression/anxiety, and those at-risk for addiction.
Our approach embeds mental health early and often, starting from the new patient intake. Here’s what you and your patients can expect:
Technology Integration: Nurocoach leverages preMR for initial data, AdvancedMD (AMD) for patient profiles and assessment templates, and Freed AI for documenting telehealth patient interactions, reducing note-taking time. We also utilize secure, EHR-integrated, and mobile-friendly two-way messaging and self-report portals for ongoing input and feedback.
For too long, the psychological evaluation, often termed "psych clearance," for chronic pain procedures like Spinal Cord Stimulator (SCS) implantation, has been a required but often undervalued step in patient care. At Nurocoach, we understand the critical need for mental health integration, recognizing that the current model falls short in several key areas.
Our integrated approach delivers measurable benefits that extend beyond traditional pain metrics:
Nurocoach streamlines operations and enhances patient care, providing tangible benefits to your practice:
For practices, integrating Nurocoach's services can generate recurring monthly revenue, even between patient visits, through appropriate billing codes:
G3002 (initial 30 minutes per calendar month) and G3003 (each additional 15 minutes). While Nurocoach psychiatrists' input strengthens the care plan, they don't bill PCM codes directly.99213, 90792) for direct patient encounters.Technology Integration: Nurocoach leverages preMR for initial data, AdvancedMD (AMD) for patient profiles and assessment templates, and Freed AI for documenting telehealth patient interactions, reducing note-taking time. We also utilize secure, EHR-integrated, and mobile-friendly two-way messaging and self-report portals for ongoing input and feedback.
The conventional approach of conducting a mental health assessment only when a neuromodulation clearance is required presents significant limitations for both patients and pain practices. This model often positions mental health evaluations as a mere administrative checkbox, rather than a crucial therapeutic step. Patients frequently perceive these clearances as judgmental, fearing they suggest they are “crazy,” which can lead to defensiveness and a lack of openness.
Instead, there is a compelling case for pain practices to integrate mental health assessments at the very outset of new patient intake, regardless of whether a procedure requiring clearance is immediately on the horizon. This proactive, holistic approach can significantly enhance patient outcomes, optimize practice resources, and foster invaluable collaborations with mental health providers.
Chronic pain is a multifactorial condition that is highly comorbid with mental health disorders such as depression, anxiety, PTSD, and substance use disorders. Studies indicate that 20-40% of adults with chronic pain experience co-occurring depression and anxiety. U.S. adults living with chronic pain are approximately five times more likely to have clinically significant unremitted anxiety or depression compared to those without chronic pain, comprising the majority (55.5%) of those with these symptoms.
Despite the high prevalence of co-occurrence, chronic pain patients often face systemic disparities in mental health care. Research shows that only 44.4% of U.S. adults with chronic pain and mental health needs receive mental health treatment that screens negative for unremitted anxiety and depression, compared to 71.5% of those with mental health needs alone. Referral completion rates for outpatient mental health are very low, with only about 10% of patients following through. This indicates a significant “treatment gap”.
Psychosocial factors, including mood, sleep, life stressors, neuroticism, substance use, physical activity, and socioeconomic factors, are powerful predictors of self-reported pain. High preoperative PHQ-9 (depression) scores correlate strongly with worse post-surgical pain, increased disability, and higher narcotic use. Pain catastrophizing, defined as a negative mental set during actual or anticipated pain, leads to higher pain reports and impedes recovery. Conversely, optimism is associated with less pain and can act as a buffer against catastrophizing, especially in individuals with high dispositional pain catastrophizing.
Introducing mental health assessments at intake provides a comprehensive understanding of a patient’s psychological makeup, including their levels of optimism, pessimism, and catastrophizing. This early insight allows for a personalized treatment plan that addresses not only physical pain but also underlying psychological and emotional barriers. This holistic approach ensures that patients are truly ready to process and maximize improvement from medical procedures.
Current “psych clearance” models are often seen as administrative burdens and lead to last-minute logistical headaches. By integrating mental health early, pain practices can proactively identify at-risk patients and provide a roadmap for their care using structured assessment tools. This reduces stress on staff resources and can potentially lead to fewer emergency department visits and unnecessary procedures by addressing issues before they escalate.
When mental health is introduced as a standard part of the intake process, it helps demystify mental health care and can reduce the stigma patients often feel when mental health is only discussed after all biomedical investigations are exhausted. Physicians, who are often highly trusted by their patients, can emphasize the importance of mental health support as an integral part of their overall care, which significantly increases patient follow-through for counseling.
Collaborating with specialized mental health groups like Nurocoach provides a structured and effective way to implement early, comprehensive mental health assessments and integrate care:
Nurocoach offers a comprehensive plan of mental health care that goes “beyond the pill,” putting counseling at the center alongside medication management, Transcranial Magnetic Stimulation (TMS), sleep and pain management coaching, and nutrition. This integrated approach ensures that patients receive multidisciplinary support, addressing both the biological and psychosocial dimensions of pain.
Nurocoach utilizes validated measures such as the Revised Life Orientation Test (LOT-R) for optimism, PHQ-9 for depression, DASS-21 for distress, and NIDA for substance use, as well as sleep assessments. These tools provide quantitative data to identify patients’ mental health status and potential risks, even allowing for the detection of “heavy catastrophizers” and those with low optimism.
Nurocoach integrates mental health intake as part of the new patient process, handling registration, pre-testing, and insurance verification. They provide pre-consult reports with patient test scores and brief histories to referring physicians. This collaboration, including regular clinical provider calls, ensures a coherent, team-oriented approach to patient care.
While biological markers are effective in predicting medical conditions associated with chronic pain, their performance for self-reported pain is limited. Psychosocial factors, however, offer a more reliable prediction of self-reported pain and its bodily distribution and impact. An integrated model acknowledges that both biological pathology and psychosocial factors interact synergistically to influence the development and expression of pain.
By embracing this holistic, front-loaded approach to mental health assessment, pain practices can more effectively address the complex, multifactorial nature of chronic pain, leading to improved patient outcomes and more efficient use of clinical resources.