Pain psychologists are specially trained to treat people living with chronic pain, who often suffer from depression, anxiety, or panic disorders.
Depression is one of the most common psychological conditions people with chronic pain face. Researchers estimate that of the nearly 50 million people living with chronic pain, about two-thirds also suffer from major depression.
Depression can negatively affect a person’s life at home and the workplace, as well as relationships with loved ones, friends, and work colleagues. People with depression experience profound sadness, guilt, and loss of energy and interest in activities.
“Depression for those individuals living with chronic pain is often undiagnosed and, as a result, it’s left untreated,” said pain psychologist Drew Sturgeon, PhD, acting assistant professor in the department of anesthesia and pain medicine at the University of Washington in Seattle.
Since there is no cure for pain or depression, individuals need to learn to manage their conditions and maximize their quality of life. Pain psychologists can help with this process. “Pain psychologists help patients become aware of the wide range of variables that can affect chronic pain conditions and help them learn how to apply coping strategies to address these issues and improve emotional and physical functioning,” said Ravi Prasad, PhD, clinical associate professor of anesthesiology, perioperative and pain medicine at Stanford Healthcare in California.
Prasad, a pain psychologist, went on to explain that depression and anxiety are commonly seen in individuals with chronic pain. Regardless of whether the emotional distress is in response to the pain or if it was present beforehand, patients often find themselves in a vicious cycle in which emotional distress and physical pain exacerbate each other.
“Helping them become aware of such relationships, the roles that thoughts, emotions and behaviors play in this process and what they can do to break the cycle, are the types of things that pain psychologists focus on,” explained Prasad.
Who are pain psychologists?
There are no recent surveys on how many pain psychologists practice in the United States. It’s a small, specialized group of a few hundred doctors practicing mainly in large metro areas. Quite a few practice in the San Francisco Bay area — about 30 to 40 doctors — because of Stanford Healthcare, which has a well-established department. Pain psychologists are not necessarily easy to find because there are so few of them and there is no one national organization that represents their profession. Some of them belong to the Society for Health Psychology, a division of the American Psychological Association, the American Academy of Pain Medicine or the American Pain Society, which has a psychosocial research section.
Pain psychologists typically hold a PhD in clinical psychology and complete a post-doctoral fellowship, which is an extra year of specialized training in chronic pain. In total, their coursework takes about nine to 10 years to complete. Pain psychologists may work in private practice or in large health-care systems, hospital rehabilitation settings, or outpatient programs.
During their training, they develop a deep understanding of the role of medical and rehabilitative interventions in pain evaluation and treatment and how to integrate them. Despite their extensive medical education, pain psychologists cannot prescribe medicines because they are not MDs. That’s why they often work with other doctors in a team-based setting to holistically treat patients.
In contrast, physicians specializing in pain management are MDs who focus on the medical aspects of a pain condition. They evaluate whether patients need to take pain medicines for their condition and whether they are taking the correct amount of medication. They may consider surgery, implantable therapies, or even injections as possible options for relief.
Pain medicine physicians also determine the types of tests needed to accurately diagnose the condition. In essence, pain medicine physicians tap into the biological aspect of a pain condition, but do not necessarily address the broader context in which the pain is occurring or the psychological consequences of chronic pain.
In some cases, individuals see both a pain medicine physician and a psychologist, but general psychologists may not have much experience treating patients living with chronic pain.
Pain psychologists address the role that psychological and behavioral factors play in the experience of pain, including assessment of sleep, activity patterns, stress, emotional distress, and use of substances such as alcohol, illicit drugs, nicotine, or caffeine. By treating pain from multiple angles using medicine, psychology, and physical and occupational therapy, pain psychologists give individuals a better chance to improve their pain, function, and overall quality of life.
Pain specialist Adam Young, MD, explained that pain is a perception, like vision or hearing. It is a combination of the sensations coming from the painful area and how those sensations are interpreted in the brain.
“How we think about our pain, our past experiences, losses resulting from the pain, and particularly how much attention we’re paying to the pain affect what we feel. If we are more distressed and feeling helpless, the pain seems more intense or overwhelming,” said Young, assistant professor of anesthesiology and pain medicine at Rush University Medical Center in the Chicago area.
He adds that “the psychologist’s role is to address the distress associated with pain and to decrease negative emotional and cognitive reactions to pain to help a patient learn to better manage the pain through behavioral changes, such as pacing or using relaxation techniques. Cognitive coping may involve mindfulness practice, acceptance, and changing thoughts that contribute to feelings of helplessness or hopelessness, helping a patient to focus on those aspects of his or her life over which he or she has control.”
Ready for a psychologist?
Even if seeing a psychologist is not something you’re comfortable doing, there are reasons to reconsider seeing a pain psychologist. See “Is it time to see a pain psychologist?” for questions to ask yourself to help determine if you should see a pain psychologist. Individuals may seek them out for a single-session evaluation to assess mood, functional ability, and pain-related problems. This is often done when patients enter a new pain center to help evaluate their needs for medication or therapy.
Patients may also have a pain psychology evaluation in cases when they are considering a more medically intense or invasive procedure, such as a spinal cord stimulator or intrathecal pump. Such evaluations can be important because research shows that patients experiencing significant psychological symptoms may not be able to get the same degree of benefit from the procedures as those who are not having those symptoms.
“It becomes a case of trying to address these psychological symptoms first to make sure that we are giving the patient the best possible chance to get benefit from whatever procedure they are considering,” said Young. “It’s also important to know that seeing a pain psychologist isn’t a rule-out for medical treatment. In fact, seeing a psychologist to manage mood problems and pain can help improve response to medical treatments for pain.”
Prasad added that another reason to see a pain psychologist is for pain-focused psychological treatment. There are several of these treatments, including cognitive-behavioral therapy, mindfulness-based stress reduction, clinical hypnosis, or acceptance and commitment therapy. “Each of these treatments has different components, but the common denominator is that they are useful in helping people deal with emotional distress, provide some skills that will either reduce pain or reduce stress, improve strategies to increase physical activity or functioning, or help to address other problems that often occur with chronic pain, such as poor sleep or problems with relationships,” explained Prasad.
Young agreed, adding, “When I see patients, I tell them that my primary focus is to find ways to improve their quality of life. This often involves some degree of pain relief and we will work to find ways to reduce pain, but even if the pain doesn’t resolve completely, I want people to feel better able to function and spend their time in ways that they find to be fulfilling and meaningful.”