Pain Management and the Role of Psychology

Author: Sean Mackey

Dr. Mackey: I liken pain management to a team sport. We need all the right players on the team. As physicians, and we all look at patients through a certain lens. But working at Stanford and also observing other places, I appreciate the value that pain psychology brings, that physical therapy brings, that all of these different viewpoints on the patient bring to the care and assessment of a person with pain. And so, I’m probably one of the biggest advocates you’ll find for having a very well-rounded team. And pain psychology is just such a critical part of that.

Dr. Darnall: The CDC guidelines and also the National Pain Strategy emphasize the role of behavioral factors, of pain psychology in the experience and treatment of pain. Most primary care physicians may not be aware of the critical role that psychology plays in the pain experience and in patient’s treatment needs. The CDC guidelines in particular, which were issued earlier this year, recommend the limiting of opioids for chronic pain. They advocate for alternatives, such as pain psychology treatments, cognitive behavioral therapy as being really the primary gold standard approach at this time. Unfortunately, we don’t have the infrastructure in place to appropriately steer patients towards these psychological treatments. Some patients do have the luxury of accessing good pain psychology treatment, but many do not. At this point, there’s a need to invest in the infrastructure, the proper education of clinicians, to ensure that all patients have the access to the treatments that the guidelines promote.

Dr. Mackey: It’s going to take all of us working together. We’re going to need the federal government. We’re going to need HHS to take a leadership role. And they are, right now, in the process of putting together an internal taskforce around this. At the same time, there’s a great opportunity for all of us to identify the areas within the National Pain Strategy that we can get behind. There’s 17 of these strategic goals. And so, if you are a person who’s suffering from pain, reach out to the patient advocacy groups. They form the consumer–patient advocacy taskforce and have come together to help promote the National Pain Strategy. If you’re a physician watching this, reach out to, for instance, the American Academy of Pain Medicine. But when you try to get behind 17 strategic goals, it gets overwhelming. So I would say find one or two, or three that resonate with you. And then, find ways to get involved to help advance those goals.

Dr. Darnall: Federal efforts that would facilitate better education are greatly needed. We also need to ensure that there’s good insurance coverage for these treatments that work. And ultimately, we need platforms that will allow clinicians, and also patients, to identify skilled pain psychology practitioners. And I would also say that from a policy perspective, additional funding for pain research is needed so that we can continue to innovate and develop treatments that are focusing on rapid access to targeted treatments. Right now, we don’t have good systems for any of these. So, there are multiple barriers that need to be dismantled.

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