Season Two, Episode Eleven: How Psychology Provides Support to the Chronic Pain Patient

This second episode focusing on the experience of chronic pain focuses on how psychologists and counselors support the patient in pain treatment. We first discuss how a person being treated for chronic pain would come to also be in psychological treatment. There are two pathways: the patient may be referred by their treating physician, or the patient may refer themselves.

Physicians who treat pain tend to refer a patient to therapy for one of three general reasons.  First, the physician may be considering a medication treatment plan that involves the use of powerful, pain-relieving opiate medication. When a physician is planning to pursue this form of treatment, it is usually recommended for the patient to be evaluated for risk factors that might argue against that treatment approach. In these cases, the physician may refer the patient for an Opioid Risk Evaluation. Second, if a patient might benefit from the implantation of a medical device, such as Spinal Cord or Peripheral Nerve Stimulator, their doctor may refer the patient for a psychological evaluation. This step is typically required by most major insurance carriers before they will pre-authorize such a procedure. The focus of the Device Evaluation is to ensure that the patient is informed about the procedure and does not have any history that might contraindicate the implantation of a durable medical device. Third, if a physician observes that some aspect of the pain treatment is causing excessive stress to a patient in a way that might be making treatment more difficult for that patient, the doctor may refer them for psychological support. These types of referrals fall under the general heading of treatment interference, meaning that the patient’s stress level might be making their recovery from chronic pain more difficult or even ineffective.

When a person in pain treatment recognizes that some aspect of the process is causing them difficulty, that person may choose to seek psychological support on their own. This is a self-referral to therapy. The therapist will listen to and support the patient in expressing their concerns and work with that person to develop affirmative strategies to cope with the stress of their pain treatment.

Once a patient is in therapy, there are several cognitive-behavioral approaches that can help them adjust to their medical treatment and get the most benefit from it. Mind-body approaches that facilitate self-regulation while supporting healthy adjustment of expectations are beneficial to patients in treatment. Helping the patient manage their communication with the treatment team is also a way to reduce stress and provide better feedback about the medical treatment plan. Keeping a pain journal, using a treatment tracker, and having a support & recovery plan all help the patient stay actively engaged in treatment and cope more successfully with what can often be a stressful experience.

By engaging psychological support as they undergo pain treatment, a person can draw on proven interventions and coping skills to make the pain journey less stressful and to make pain treatment more effective.