This section will focus on the psychological evaluation and management of patients with chronic pain. In 1977, Dr. George Engel proposed a biopsychosocial model of illness in patients with chronic pain. This model takes a more global and holistic approach to evaluating these patients, more so than a reductionist biomedical model. And this model accounts for various factors, including biological, psychological, social, and cultural impacts on the patient's pain and behavior. It also is now considered a more comprehensive and compassionate approach. This comprehensive biopsychosocial model of patients with chronic pain allows us to utilize a multidisciplinary treatment approach to treat them in a multifaceted approach. Many patients with chronic pain exhibit other coexisting phenomenon, including sleep disturbances, fatigue, perceived high disability ratings, substance abuse, suicide risk, and various mood disorders, such as depression and anxiety. It is important as clinicians to recognize the coexisting nature of these conditions. When we evaluate patients with chronic pain, it is important to have a comprehensive history and physical examination. This includes a thorough history of their medical and surgical history, as well as their substance use history, social history, family history, and psychiatric history. It is also important to take input from the patient, caregivers. Use your own personal observation and the physical exam to guide your treatment plan. There are various assessment tools that can be utilized in evaluating the patients with chronic pain from a biopsychosocial perspective. A psychological inventory can be taken using the QIDS, or the Quick Inventory of Depressive Symptoms. Some clinicians may also prefer functional questionnaires, such as the Brief Pain Inventory, or the PDQ, the Pain Disability Questionnaire. And there are several others, including the Oswestry Disability Index and the Roland Morris Disability Questionnaire. The idea of a multidisciplinary pain management approach for patients with chronic pain involves utilization of a multimodal team approach to manage their broad range of symptoms. There are various disciplines that can be involved in the patient's care, including pain management physicians, such as PM&R or anesthesia physicians, psychologists, physical therapists, primary care teams, and other support team members. The key is to focus, as a team, on improving the patient's pain, as well as the patient's mood, function, and quality of life. An argument can be made that all patients with chronic pain can benefit from psychological therapy. It can be specifically beneficial for patients whose psychological and behavioral approach is interfering with their ability to fully benefit from other aspects of the treatment plan. Some patients who can benefit from earlier psychological intervention for their chronic pain include patients with high levels of psychological distress, patients with poor self-perception or negative coping mechanisms, and patients who have aberrant medication use or uncontrolled pain. There are various psychological treatment options for chronic pain. And in general, it is recommended that these interventions should be individualized for each particular patient and their situation. This slide shows a list of some commonly used psychological treatment options, including operant behavioral therapy, cognitive behavioral therapy, mindfulness-based therapy, and acceptance slash commitment therapy. In summary, the overall goals of pain psychology therapy include providing patients insight on the impact of various psychosocial factors on their pain level, their function, and their quality of life, and to treat any coexisting mood impairments such as depression or anxiety that can interfere with their progress in managing their pain. And ultimately, with these treatment options, the patients can hopefully have better and improved cognition and self-control of pain, as well as an overall healthier lifestyle and behavior.

biopsychosocial model

chronic pain

multidisciplinary team

coexisting conditions

pain psychology therapy