Psychological considerations in the care of patients with chronic pain


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Presentation to the Texas Physical Therapy Association, Houston, TX January 2011

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Psychological considerations in the care of patients with chronic pain

  1. 1. Psychological Considerations in the Care of Patients with Chronic Pain Rachel Tova Winer, Ph.D.
  2. 2. The Value of Psychological Evaluation• A good psychological assessment is essential for patients with pain• Elements of a good pain evaluation• Methods
  3. 3. Subtleties of Assessment• Factors that interfere with accuracy• Common mistakes• Behavioral signs in assessing pain intensity
  4. 4. Psychological Insights• Interview format• Establishing time of onset• Reviewing failed treatments
  5. 5. The Impact of Pain• Is emotional distress a normal consequence of illness and pain? Adaptive vs. Maladaptive• Areas of function
  6. 6. Family Issues• Influence exerted by family members• Family dynamics• Sexual activity• Parallel history
  7. 7. Coping Behaviors• Adaptive vs. Maladaptive• Pain behaviors• Secondary gain
  8. 8. Making the Subjective (More) Objective • WHYMPI • MMPI and the “neurotic triad” • SCL-90R • BDI (depression) • SIP (level of disability) • POMS
  9. 9. Trauma and Abuse• Medical consequences of a history of abuse• Complaints associated with abuse history• How prior experiences of abuse impact rehab
  10. 10. FAQs• Do I have to be a psychologist to effectively treat a patient with psychological difficulties?• How can my treatment be more effective than the lure of disability or compensation?• When should I make a mental health referral?• How can I manage my own feelings about patients?
  11. 11. Common Psychological Treatments for Patients With Pain• Relaxation, sleep hygiene, and stress management strategies• Cognitive therapy, problem-solving, communication skills training, motivational strategies• Behavioral: promoting well behavior/reinforcement, goal setting, hypnotic principles• Family therapy• Group therapy
  12. 12. Putting the “hab” in “rehab”• Understand the psychology in the perplex of pain• Be aware of the need to treat comorbid problems• Recognize the application of psychological strategies to specific pain syndromes• Learn how different approaches may be integrated
  13. 13. Psychologists and Physical Therapists...• Address patients at different stages of change• Recognize the importance of self- management• Match interventions to patients’ needs• Consider racial, ethnic, and cultural factors
  14. 14. Resources• Caudill, MA. Managing Pain Before it Manages You. New York: Guilford Press, 2002.• Charlton JE (Ed.) Core Curriculum for Professional Education in Pain. Seattle: International Association for the Study of Pain Press.• DeGood DE, Dane JR. The psychologist as pain consultant in outpatient, inpatient, and work settings. In Gatchel RJ, Turk DC (Eds.) Psychological Approaches to Pain Management. New York: Guilford Press, 1996, pp 403-437.• Kabat-Zinn J. Full Catastrophe Living. New York: Delta Press, 1990.• Kerns RD, Rosenburg R, Jamison R, et al. Readiness to adopt a self- management approach to chronic pain: the Pain Stages of Change Questionnaire. Pain 1997; 72:227-234.