Psychological considerations in the care of patients with chronic pain
Psychological Considerations in the Care of Patients with Chronic Pain Rachel Tova Winer, Ph.D.
The Value of Psychological Evaluation• A good psychological assessment is essential for patients with pain• Elements of a good pain evaluation• Methods
Subtleties of Assessment• Factors that interfere with accuracy• Common mistakes• Behavioral signs in assessing pain intensity
Psychological Insights• Interview format• Establishing time of onset• Reviewing failed treatments
The Impact of Pain• Is emotional distress a normal consequence of illness and pain? Adaptive vs. Maladaptive• Areas of function
Family Issues• Influence exerted by family members• Family dynamics• Sexual activity• Parallel history
Coping Behaviors• Adaptive vs. Maladaptive• Pain behaviors• Secondary gain
Making the Subjective (More) Objective • WHYMPI • MMPI and the “neurotic triad” • SCL-90R • BDI (depression) • SIP (level of disability) • POMS
Trauma and Abuse• Medical consequences of a history of abuse• Complaints associated with abuse history• How prior experiences of abuse impact rehab
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?
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
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
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
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.