September is Pain Awareness Month, sponsored by the American Chronic Pain Association.

As many as 100 million Americans suffer from chronic pain (pain that lasts longer than 6 months). But when their primary health care providers suggest seeking psychological treatment, patients can feel dismissed – or worse, as though their provider thinks they’re either making up their symptoms or suffering from a mental health disorder.

“Very few people come in just overjoyed at the idea of seeing a pain psychologist, because what they hear – and what people sometimes say outright – is that it’s a last resort,” says Beth Dinoff, PhD, one of two pain psychologists at University of Iowa Hospitals & Clinics’ Pain Management Clinic. “In reality, pain psychology should be a first resort, because the research science behind it is so robust. And patients really benefit from the experience.”

Researchers are just beginning to understand how physical pain and emotions are connected, but they have learned that both are centered in the brain. Physical pain and emotions can – and often do – influence each other. This connection can set up two vicious cycles that perpetuate each other: Physical pain can evoke feelings of anger, depression, loss, and isolation, and those feelings can make physical pain feel worse, triggering even deeper negative emotions.

Among other findings in the body of research on the topic:

•    Pain and depression are both present in up to 60 percent of cases.
•    Anxiety disorders are present in at least 35 percent of cases.
•    More than a third of chronic pain patients also suffer from post-traumatic stress disorder (PTSD).
•    Nearly 9 in 10 people with PTSD also report chronic pain.
•    More than 6 in 10 patients who seek help for substance abuse have chronic pain.

“I tell people that I treat physical pain and the effects of physical pain, such as sadness, social isolation,  and changes in functioning,” Dinoff says. “There are many changes that happen with hurting all the time. People with chronic pain are not crazy. It’s not all in their heads. They hurt. And they hurt a lot.”

Referring providers can better help their patients who suffer from chronic pain by viewing – and presenting – pain psychology as an integral part of a treatment plan.

“Pain psychologists are part of a team of qualified experts who collaborate to help the patient get to the best possible outcome,” Dinoff says. “And we have longer appointments than medical doctors do, so we can use some of that time to encourage and support the rest of the treatment plan, such as trying to reduce dependence on medications or promoting participation in physical therapy to increase function levels. It’s a more holistic, team-oriented approach than working with a single provider.”

To help patients see the value in a referral to pain psychology, Dinoff recommends emphasizing this team approach and suggests phrases like these:

•    I believe that you are hurting.
•    This pain is greatly impacting your life.
•    Chronic pain is best treated by a team of qualified experts.
•    Pain psychology is one of the evidence-based treatments for persistent physical pain.
•    I’d like to have pain psychology collaborate in the treatment of your chronic pain.

“These are gentle ways to validate what the patient is experiencing and assure them that you’re not dismissing their pain,” Dinoff says. “Some patients may need time to get used to the idea. But for some patients, these simple statements may be the first time that patients feel like someone really listened to what they were trying to say.”

About the Pain Management Clinic
The Pain Management Clinic at University of Iowa Hospitals & Clinics is an evidence-based, multidisciplinary clinic that addresses the physical, mental, and emotional aspects of chronic pain. In addition to board-certified pain physicians, the Pain Clinic has two licensed clinical psychologists who work exclusively with chronic pain patients. To refer a patient to the Pain Management Clinic, see our Resources for Referring Providers.