Integrating Pain Psychology Into Training Programs, Continuing Education

In response to a call for improved pain management training from the Institute of Medicine and the Oversight Committee for the NIH Health and Human Services National Pain Strategy, a task force assessed stakeholders’ perspectives on pain psychology and outlined needed resources.

Chronic pain is estimated to affect over 100 million people in the US and is associated with an annual financial burden of up to $635 billion.¹ Though psychology has long been recognized as essential in alleviating the pain experience, and a sizable body of research has underscored the importance of psychological factors in pain management and outcomes, these interventions are often overlooked or minimally addressed.^2-4

Instead, the typical treatment approach is based on a biomedical model rather than a biopsychosocial one. “A remaining focus on the biomedical approach to pain treatment is simply a vestige of the past and a reflection of enduring educational needs for medical providers and all healthcare clinicians,” as well as public education, said Beth Darnall, PhD, a clinical associate professor in the Division of Pain Medicine at Stanford University, and co-chair of the Pain Psychology Task Force at the American Academy of Pain Medicine.

In a recent article published in Pain Medicine, Dr Darnall and collaborators at multiple US institutions wrote a report, which they say “calls for transformation within psychology predoctoral and postdoctoral education and training and psychology continuing education to include and emphasize pain and pain management.”⁵

This report, based on 1,991 responses gathered from surveys of stakeholders from 6 different fields, including mental health practitioners, patients with chronic pain, various types of referring clinicians, and directors of psychology training programs, indicates wide-ranging support for integration of pain psychology into training programs and continuing medical education.

The findings show that, while over 75% of referring providers are cognizant of pain psychology, 37% of patients with chronic pain do not know of pain psychology as a treatment approach.

“Most patients are not aware that psychology is built into the definition of pain, and many medical clinicians are similarly unaware of the integral role of psychology and psychosocial factors in the experience of pain,” Dr Darnall told Clinical Pain Advisor. “In fact, psychosocial factors are some of the most powerful determinants of pain outcomes—they largely determine whether medical treatments work or not,” she said.  

This lack of awareness represents one of the primary barriers identified in the needs assessment, and another major barrier is education of psychologists and other therapists.

Among responding mental health clinicians who did not identify as pain psychology experts, 72% indicated that they had received minimal or no training regarding pain treatment.

The authors suggest that no-cost pain psychology curricula should be added to graduate and postgraduate psychology programs, a measure unanimously supported by directors of such programs. 

In addition, the need for a centralized database of pain psychology practitioners is highlighted. Such a database would facilitate access for patients and referring providers–these insurance reimbursement issues need to be addressed on a policy level.

“We must remind patients and clinicians that healthcare and pain care is less about what the doctor does, and more about what the patient does on a daily basis,” notes Dr Darnall. “In emphasizing this message, the role of psychology becomes quite obvious,” she said.

References

1. National Institutes of Health: National Institute of Neurological Disorders and Stroke Pain: Hope Through Research. Available at: http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm. Accessed August 8, 2016.
2. IASP Task Force on Taxonomy. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Seattle: IASP Press; 1994. 
3. Masselin-Dubois A, Attal N, Fletcher D, et al. Are psychological predictors of chronic postsurgical pain dependent on the surgical model? A comparison of total knee arthroplasty and breast surgery for cancer. J Pain. 2013; 14(8):854–864.
4. Linton SJ. Do psychological factors increase the risk for back pain in the general population in both a cross-sectional and prospective analysis? Eur J Pain. 2005; 9(4):355–361.
5. Darnall BD, Judith Scheman J, Davin S, et al. Pain psychology: A global needs assessment and national call to action. Pain Med. 2016; 17(2): 250–263.