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Pain and Spine Medicine

Evaluating the MoCA and GAD-7 Scales as Predictors of Spinal Cord Stimulation Trial Outcomes: A Retrospective Cohort Study

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 10
Has Audio
Disclosure(s):
Madison Niermeyer, PhD: No financial relationships to disclose
Jess Farrar, PhD: No financial relationships to disclose
Ali Arafat, MD: No financial relationships to disclose
Hasan Sukru Sen, MD: No financial relationships to disclose
Taylor Burnham, DO: No relevant disclosure to display
Aaron M. Conger, DO: No financial relationships to disclose
Zachary McCormick, MD: No relevant disclosure to display
Background and/or Objectives: Psychological evaluation is a widely adopted tool for assessing spinal cord stimulation (SCS) candidacy. If severe psychiatric comorbidities are identified, patients may be excluded from trialing SCS and considered ineligible for implantation. However, there is no consensus on which screening measures most effectively predict SCS trial and implant outcomes, and the role of cognitive screening remains particularly understudied. This study examined associations between varying degrees of SCS trial success and screening results for cognitive function and anxiety, as measured by the Montreal Cognitive Assessment (MoCA) and the General Anxiety Disorder-7 (GAD-7), respectively.

Design: Retrospective cohort study

Setting : Single academic medical center

Participants : Patients with a successful SCS trial between 2018 and 2023 whose pre-screening psychological evaluations included the MoCA and GAD-7.

Interventions: Not applicable

Main Outcome Measures: SCS trial pain improvement (50-79% versus ≥80% improvement)

Results: We identified 58 patients (62.1% female; 60.6±16.4 years of age). In this cohort, average MoCA and GAD-7 scores were 25.4±3.3 (range: 14-30) and 5.6±5.2 (range: 0-17) points, respectively, with 39.7% (n=23) of patients reporting ≥80% pain relief during their SCS trial period. Logistic regression analysis revealed that, after controlling for gender, age, and BMI, the presence of mild to severe anxiety (vs. minimal or no anxiety) decreased the odds of achieving ≥80% pain relief during the SCS trial (OR=0.18; p=0.015), while MoCA scores had no statistically significant effect on this outcome (p>0.05).

Conclusions: Clinically significant anxiety on the GAD-7 appears to predict lower magnitudes of pain relief during SCS trials in patients who met the threshold of >50% pain relief. MoCA screening results were not associated with the degree of pain improvement from SCS trial. Further studies are necessary to determine whether these associations remain significant with long-term outcomes following permanent SCS implantation.