How psychologists can help treat chronic pain

How do you find a pain psychologist?

Finding a pain psychologist can be difficult. Comprehensive pain treatment is more likely to occur in larger medical centers and boutique practices, but it also occurs in urban areas. Rachel Aarons, assistant professor of physical therapy and rehabilitation at Johns Hopkins Medicine, said people in rural areas or who can’t afford services tend to miss out. But even in urban areas, not all large medical networks have pain services.

“It’s certainly a challenge moving from initial pain diagnosis to psychological care, no matter what system you’re in,” Dr. Aaron said.

There are no specific certifications for pain management therapists, nor does the American Psychological Association track their numbers, said Eric Garland, director of the Center on Mindfulness and Integrative Health Intervention Development at the University of Utah. But most experts agree that pain-focused psychologists, like other mental health professionals, are lacking.

If you’re interested in trying a pain therapist, Dr. Aaron said, the first stop is your primary care physician. Some insurance plans cover pain psychology, but others do not. It is important to talk to a mental health provider first about how to cover treatment.

After that, look for specialized pain clinics by calling hospitals in your area or using the Find a Therapist function on the Psychology Today website. Look for a provider who either treats your specific condition, be it fibromyalgia or migraine, or who treats chronic pain more broadly, often referred to as behavioral medicine or health psychology. There are also online programs that are evidence-based and freely available; Dr. Aaron recommends PenTrainer and Pain Course.

Some experts recommend working with licensed professionals with a doctorate or master’s degree in psychology or clinical social work with additional training in chronic pain and interviewing them about their training and outlook before starting.

“If they can’t give a clear answer on their approach or how they will treat your specific pain issue, they probably don’t have good training,” Dr. Garland said.

Most importantly, you should feel comfortable enough to open up to them.

What should you expect?

Most pain therapy programs begin with six to eight weekly sessions, said Fadel Zidane, MD, an associate professor and executive director of anesthesiology at the Center for Mindfulness at the University of California, San Diego. Often the first session is an assessment to learn about the problem of pain and the emotional problems it causes. You can then learn mindfulness techniques to separate the physical and emotional aspects of pain, train yourself to reframe negative thought patterns, or practice paying more attention to pleasant sensations.

A recent paper in JAMA Psychiatry found that two-thirds of chronic back pain patients who underwent four weeks of psychological treatment were pain-free, or nearly after. However, most studies show a more modest effect – about a third of the participants saw a significant reduction in pain.

To put this in perspective, this is similar to the effects of opioids on chronic pain, but those benefits wear off over time (and they come with risks). On the other hand, the effectiveness of psychological pain management skills can increase with practice.

Dr. Zidan recommends trying different approaches at once – individual therapy, pain management courses, and group therapy. “We don’t really know what the silver bullet is because it’s unlikely to cure pain. So testing, validating and optimizing multiple approaches is an important step.”

What if you can’t see a psychologist in person?

The definitions used by insurance companies for chronic pain are changing rapidly – ​​pain is increasingly seen as a disease of its own – but for now it is difficult to visit for a pain psychologist. This can put face-to-face treatment out of reach for many people.

“We don’t have enough trained psychologists to meet all the needs,” said Beth Darnall, director of the Stanford Pain Relief Innovation Lab. “We really have to look beyond what we’re doing right now.”

Darnall said the technology could provide new options, as many of the psychological tools shown to reduce pain can be learned and shared with minimal training. She has created a program based on CBT and other models, called Empowered Relief, which is economical and can be done from your own home.

Patients can sign up, often for free, for a two-hour online class given on their own or by one of 300 instructors, all healthcare professionals, who provide simple skills to calm the nervous system, relieve pain. and change how your brain processes it. It is integrated into the Cleveland Clinic for chronic pain and spine surgery patients, as well as several insurance companies. In one test, a single class was the equivalent of eight sessions of CBT, an app she is currently working on and even a virtual reality platform.

“You can live on a farm in Idaho and have quality access to evidence-driven pain care,” she said.

Darnall stressed that psychological counseling is just one component of a chronic pain treatment program, which may also include medication or lifestyle changes.

“It’s not psychological treatment or medicine,” Dr. Darnall said. “It’s a menu, and patients can land on two or three different options that offer a good formula for them.”

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