Pain Psychology for pain management

Chronic pain is often about breaking vicious cycles.   It’s normal for us to avoid what brings us pain, but when pain is persistent, that avoidance can get us into trouble.  Not only do people become weaker and deconditioned, but stress increases and it changes dynamics at home and work when you can’t do what you need to do. There are fewer distractions from pain and fewer opportunities to improve mood when people miss out on fun and social activities.  The increase in stress and depression increases physiologic activation and changes brain chemistry, making pain worse.  Sleep can become disrupted due to pain flares, and we don’t mentally or physically recover with insufficient sleep.  Most people with chronic pain realize that they are falling into a downward spiral, but struggle to reverse course.

Pain psychology provides cognitive and behavioral strategies to increase functioning and quality of life even with pain.   Seeing a pain psychologist won’t repair the physical damage that caused pain, so pain may persist, but physical condition, mood, stress, relationships, focus of attention and sleep will improve and stop feeding into pain.

American Chronic Pain Association

ACPA Resource Guide to Pain Medication and Treatments

It is important for the public to realize that few doctoral and masters programs offer courses in Pain Psychology and not all providers who treat chronic pain are focused on improving functioning. Some providers are simply offering support during difficult transitions while others are inadvertently reinforcing negative behaviors. The most common example is that a mental health provider may discourage a chronic pain patient from engaging in a certain activity because it is uncomfortable and distressing. A provider trained in Pain Psychology focuses on teaching skills so that the patient can engage in more activity, ask for support when they need it, and set realistic goals for themselves.

In order to find a provider who is truly trained in Pain Psychology, it is important to ask them four questions:

1. Do they have the special expertise or training in chronic pain?
2. Do they understand the biopsychosocial model?
3. Are they trained in cognitive behavioral therapy and mindfulness?
4. Are they familiar with working with multidisciplinary teams?

A good indication of this would be that the provider is associated with a functional restoration program or they are part of a clinic that includes biopsychosocial interventions.