The International Association for the Study of Pain defines pain as being both a noxious sensory and emotional experience, so psychology is actually integral to the experience of pain, but we don’t often treat it that way. I advocate for greater appreciation of the psychosocial dimensions of the pain experience because these are often ignored and undertreated and are important therapeutic targets to help our patients reduce pain and suffering and, ultimately, need for various treatments including opioids. Pain catastrophizing, or what I like to call a negative pain mindset, is when individuals will have difficulty focusing on anything but the pain and how awful it is. This is natural and understandable particularly in the context of severe pain and ongoing pain, but it’s important that we equip individuals with various skills to be able to reduce the distress that pain causes because when it’s left untreated, it actually feeds back into the pain experience, amplifying pain and treatment needs. Nocebo is a belief that something will be detrimental to us. These nocebo fears are quite salient in a climate where there is rapid opioid reduction, forced tapering, or even if an individual just simply has ongoing pain and has a negative expectation that that pain is likely to worsen. It’s important that we identify and address nocebo beliefs and thoughts so that individuals aren’t unwittingly amplifying pain and distress.
The most important advice that I can give primary care practitioners is to introduce your patients to the role of psychology in the experience and treatment of pain; to normalize psychological treatment as being empowering versus a treatment of last resorts because that leads patients to feel judged or blamed or that they did something wrong. We have failed the patients by not introducing psychology, behavioral medicine, and self-management strategies as early on in the process as possible. What the data tells us is that when we integrate psychology on the front end of treatment, it allows patients better response to all of the medical treatments that are tried later, so we’re setting our patients up for success.