Psychological Services Offered in Chronic Pain Management

By David Cosio, Ph.D.
November 7, 2016



chronic pain management with psychological servicesPsychological services have become an integral component of chronic pain treatment in most treatment settings. As an early career psychologist, this is what you need to know about practicing in a multidisciplinary pain management clinic.

There are several reasons a patient with chronic pain could be referred to a psychologist. The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Pain physicians recognize that chronic pain is real. Referring a patient to a psychologist is important because there are limits to what traditional medical treatments, such as medications, interventions and surgery, can accomplish with chronic pain.

A psychologist may be able to help create a better multidisciplinary self-management plan to address the chronic pain by adding other non-drug interventions, such as psychological approaches and complementary alternative medicine (CAM) modalities such as acupuncture, spinal manipulation, movement programs (e.g. yoga or Tai Chi), and massage therapy. There is promising scientific evidence to support the use of CAM for non-cancer pain conditions. Psychologists also take on roles in the development and coordination of patient pain education programs.

A psychologist may also be able to help a patient learn better ways to manage stress and other difficult emotions connected to the pain. Being in chronic pain can be disheartening, so a certain level of depression, anger, anxiety and other emotions may be expected.

Patients who do not address unpleasant emotional experiences may in fact experience more physical pain because the same part of the brain that is responsible for pain is also responsible for emotions. Sometimes these emotions may require additional treatment, such as evaluation, education, psychotherapy or medications.

Psychological approaches, such as biofeedback, hypnosis, cognitive-behavioral therapy (CBT) and mindfulness-based interventions, aim to modify the overall pain experience, help restore functioning and improve the quality of life of patients who suffer from chronic pain.

Acceptance and Commitment Therapy (ACT) and traditional CBT are among the most utilized interventions in psychology for chronic pain. Past research has shown that ACT compares favorably with traditional CBT in the treatment of chronic pain among different populations.

Patients may also be referred to a psychologist before undergoing a procedure, such as a Spinal Cord Stimulator trial, which requires a psychological evaluation. There are also many changes patients who suffer from chronic pain can actively make in their lifestyle to help their pain and emotional state, including diet, sleep, hygiene, physical activity and spiritual needs. Psychologists bring considerable unique expertise in health promotion and disease prevention that affect chronic pain.

A wise supervisor once told me that as an early career psychologist, I would begin my career practicing psychotherapy and would eventually move toward teaching and supervising. Psychologists may also take on administrative tasks and leadership roles in pain clinics.

For example, a psychologist may be responsible for training different trainees from a variety of disciplines, including psychology, in chronic pain management. They are integral members of staff meetings and can make considerable contributions to case conferences.

Additionally, early career psychologists can take advantage of their scientist-practitioner training by conducting research in pain treatment settings to help fill the gaps in knowledge regarding pain evaluation and treatment.

The role of psychology has the potential to grow in the areas of policy development and in the legislative process. As the health care system continues to prioritize cost containment, psychologists must educate stakeholders about the importance of psychological treatment in chronic pain management. Early career psychologists have a responsibility not only to help reduce the suffering of patients with chronic pain, but also their long-term health care utilization by continuing to provide evaluation, education and psychotherapy.

References available from author.

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David Cosio, Ph.D., works in the pain program at Jesse Brown VA in Chicago. He received his degree from Ohio University in 2008, completed an internship at the University of Massachusetts-Amherst, and a post-doctoral fellowship at the Edward Hines Jr. VA. His email address is: david.cosio2@va.gov.

 

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