The Psychology of Pain

Question: I'm in constant, terrible pain (it peaks at 8 every day), and I've lived with this chronic back pain for close to 15 years. I've tried the best I can to keep a good attitude and stay optimistic, but it's hard, so hard. Just recently, my doctor referred me to a psychologist. Why would he do that? Does he think I'm going crazy and making up my pain? What good will a psychologist do when it's my body that's in pain?
—Ithaca, NYWoman in an appointment with a psychologistAnswer: I can understand how it would feel that way. However, being sent to a psychologist isn't a sign that your doctor believes that you've made up 15 years of intense pain. Instead, it's a sign that he's taking a multi-disciplinary approach to your chronic pain treatment.

Usually a physician will include a psychologist in your treatment because he or she believes that a multi-disciplinary approach is the best way to address your chronic pain treatment. Using this approach, experts from different disciplines work together on a treatment team with the goal of decreasing your pain and increasing the things you can do. This is known as your functionability.

These multi-disciplinary treatment plans—such as the ones developed at the practice where I work (the Center for Pain Management in Indianapolis, IN)—take into consideration how the chronic pain is keeping you from fully living and functioning the way you'd like. The treatment team works together to provide you with the tools to improve your functionability.

After all, chronic pain takes a toll on your life, as I'm sure you know from first-hand experience. It is a constant stressor to be in pain all the time. Furthermore, giving up many of the things you used to do because of the chronic pain can cause symptoms of anxiety and depression. Depending on how disruptive it is to your life and roles, this can lead to anxiety, depression, and panic disorders. In short, chronic pain is about more than the physical experience of pain, so an optimal chronic pain treatment plan will probably need to include more than just treatments that target the physical pain.

Let me explain briefly what I do in the first appointment. This may help assuage your concerns about being sent to a psychologist.

During the first appointment, I try to get an idea of how the pain is affecting the patient's life. As I mentioned before, many patients come to me feeling depressed or dealing with anxiety. Living with a chronic medical condition creates another level of stress in a patient's life. So I use this time to assess how they have adjusted to living with their chronic medical condition and what adjustments they have not been able to make. In this initial meeting, I also evaluate if there are tools and/or techniques I could provide the patient with to help him or her cope with the pain.

After the first appointment, the multi-disciplinary team at the Center for Pain Management sits down to discuss treatments plans for particular patients. For chronic pain patients, I find it very useful to be part of this team approach: all the specialists are focused on improving the patient's quality of life, and we can stay abreast of all of the treatments a patient is receiving. Working together, we can make the best recommendation to the patient. Of course, as with any treatment approach, acceptance of the treatment is always up to the patient.

Not every patient needs a follow-up appointment (or appointments) with me. Each treatment plan is individualized, so this depends upon the needs of the patient.

For example, after my evaluation of the patient, I may believe that he or she could benefit from learning some relaxation techniques. Perhaps living with chronic pain has made his or her body and mind very tense—unable to adequately relax. That tension can actually amplify the daily experience of pain.

In my work with this patient, I might teach him or her various relaxation techniques, diaphragmatic breathing, and meditation that the patient can use to calm the body and mind. These are techniques the patient can then use on his or her own in daily life to manage the pain and stress. Being less fraught with tension may make it easier for the patient to do some of the "daily life" things that had become difficult, thus in turn decreasing his or her pain and increasing the things he or she can do with less pain.

Your appointment with the psychologist shouldn't make you feel that the doctor questions your mental status, but actually it reflects that your doctor was really listening to you and heard that you have been suffering from chronic pain for a long time. I hope that through my brief explanation of the role of a psychologist in chronic pain treatment, you may see that this referral may, in fact, be beneficial to your overall treatment. The psychologist will work with you to figure out what works best so that you can get through the day with a better handle on your pain and get back to your life.