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Question: I'm in constant, terrible pain (it peaks at 8
every day), and I've lived with this chronic back pain for close to 15 years.
I've tried the best I can to keep a good attitude and stay optimistic, but it's
hard, so hard. Just recently, my doctor referred me to a psychologist. Why would
he do that? Does he think I'm going crazy and making up my pain? What good will
a psychologist do when it's my body that's in pain?
—Ithaca, NY
Answer: I can understand how it would feel that way. However,
being sent to a psychologist isn't a sign that your doctor believes that you've
made up 15 years of intense pain. Instead, it's a sign that he's taking a multi-disciplinary
approach to your chronic pain treatment.
Usually a physician will include a psychologist in your treatment because he
or she believes that a multi-disciplinary approach is the best way to address
your chronic pain treatment. Using this approach, experts from different disciplines
work together on a treatment team with the goal of decreasing your pain
and increasing the things you can do. This is known as your functionability.
These multi-disciplinary treatment plans—such as the ones developed at
the practice where I work (the Center for Pain Management in Indianapolis, IN)—take
into consideration how the chronic pain is keeping you from fully living and
functioning the way you'd like. The treatment team works together to provide
you with the tools to improve your functionability.
After all, chronic pain takes a toll on your life, as I'm sure you know from
first-hand experience. It is a constant stressor to be in pain all the time.
Furthermore, giving up many of the things you used to do because of the chronic
pain can cause symptoms of anxiety and depression. Depending on how disruptive
it is to your life and roles, this can lead to anxiety, depression, and panic
disorders. In short, chronic pain is about more than the physical experience
of pain, so an optimal chronic pain treatment plan will probably need to include
more than just treatments that target the physical pain.
Let me explain briefly what I do in the first appointment. This may help assuage
your concerns about being sent to a psychologist.
During the first appointment, I try to get an idea of how the pain is affecting
the patient's life. As I mentioned before, many patients come to me feeling
depressed or dealing with anxiety. Living with a chronic medical condition creates
another level of stress in a patient's life. So I use this time to assess how
they have adjusted to living with their chronic medical condition and what adjustments
they have not been able to make. In this initial meeting, I also evaluate if
there are tools and/or techniques I could provide the patient with to help him
or her cope with the pain.
After the first appointment, the multi-disciplinary team at the Center for
Pain Management sits down to discuss treatments plans for particular patients.
For chronic pain patients, I find it very useful to be part of this team approach:
all the specialists are focused on improving the patient's quality of life,
and we can stay abreast of all of the treatments a patient is receiving. Working
together, we can make the best recommendation to the patient. Of course, as
with any treatment approach, acceptance of the treatment is always up to the
patient.
Not every patient needs a follow-up appointment (or appointments) with me.
Each treatment plan is individualized, so this depends upon the needs of the
patient.
For example, after my evaluation of the patient, I may believe that he or she
could benefit from learning some relaxation techniques. Perhaps living with
chronic pain has made his or her body and mind very tense—unable to adequately
relax. That tension can actually amplify the daily experience of pain.
In my work with this patient, I might teach him or her various relaxation techniques,
diaphragmatic breathing, and meditation that the patient can use to calm the
body and mind. These are techniques the patient can then use on his or her own
in daily life to manage the pain and stress. Being less fraught with tension
may make it easier for the patient to do some of the "daily life" things that
had become difficult, thus in turn decreasing his or her pain and increasing
the things he or she can do with less pain.
Your appointment with the psychologist shouldn't make you feel that the doctor
questions your mental status, but actually it reflects that your doctor was
really listening to you and heard that you have been suffering from chronic
pain for a long time. I hope that through my brief explanation of the role of
a psychologist in chronic pain treatment, you may see that this referral may,
in fact, be beneficial to your overall treatment. The psychologist will work
with you to figure out what works best so that you can get through the
day with a better handle on your pain and get back to your life.
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