By Les Aria, PhD I December 4, 2024
Read Time: 3-4 minutes
We all know that pain psychology is a critical part of pain management. But discussing a referral to pain psychology can sometimes be challenging. In this blog, we will explore four common pitfalls and share a step-by-step approach using motivational interviewing techniques to build trust and enhance patients' quality of life.
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Pain Psychology applies behavioral skills to retrain the brain’s messages of danger that contribute to the perception of pain.
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Case Example
A 68-year-old female presents for a follow-up visit. She has been experiencing chronic low back pain for the past 10 years and has a documented history of situational depression and anxiety disorder.
This is her fourth visit, and she reports that physical therapy exacerbates her pain, while medical interventions, including medications and injections, have failed to provide relief or improve her functionality. During routine screenings, you note a worsening of her depressive and anxiety symptoms compared to her initial presentation.
When you recommend consulting with a psychologist or therapist as part of her new care plan (noting that pain psychology was not included in her initial treatment options), she becomes visibly upset and accuses you of implying that her pain is "all in her head."
The Four Commons Pitfalls
Neglecting Empathy and Validation
Pitfall: Jumping straight to solutions without acknowledging the patient’s emotional experience.
Solution: Begin by validating their struggles and demonstrating an understanding of the complexity of chronic pain. Acknowledge their frustrations and make them feel heard.
Minimizing the Patient’s Pain
Pitfall: Suggesting that pain is mainly due to anxiety or depression, which can come across as dismissive.
Solution: Validate their pain as real. Use physiological terms (eg "Nervous System") to emphasize the interconnectedness of physical and psychological factors.
Assuming Patients Understand the Role of Psychology
Pitfall: Believing patients are already familiar with pain psychology.
Solution: Explain how over time, the nervous system learns to stay in a heightened state. Learning skills to dial down your pain system is key to improving their quality of life and will help their functionality.
Avoiding Patient Skepticism
Pitfall: Ignoring or dismissing patient doubts about psychological approaches.
Solution: Address skepticism openly and provide evidence-based insights. Reassure them: “It’s okay to have doubts. Put that doubt in your pocket and take this step toward getting your life back.”
The Motivational Interviewing Rhythm: Ask, Ask, Tell, Ask
Motivational interviewing provides a structured yet flexible approach to guiding these conversations:
Ask: Can you tell me if you are getting any pain relief since our last visit?
Ask: Would you be open to something I think could help you?
Tell: I’d like to refer you to my colleagues at Menda Health who provide online pain therapy. This has helped many patients improve their pain and quality of life.
Ask: Can I get that referral started for you today?
This rhythm keeps the conversation patient-centered, ensuring they feel supported and engaged.
Final Thoughts
By thoughtfully addressing these five pitfalls, you can foster greater trust and open communication with your patients. The motivational interviewing rhythm—Ask, Ask, Tell, Ask—helps emphasize the value of integrating psychology into pain management while respecting the patient’s perspective. These conversations validate their experiences and empower them to embrace evidence-based psychological strategies, ultimately enhancing their quality of life. With empathy, clarity, and collaboration, you can guide your patients toward a more holistic and effective approach to managing chronic pain.
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ABOUT THE AUTHOR
Les Aria, PhD is a pain psychologist of 20 years and one of the co-founders of Menda Health. His passion for nervous system interventions promotes a unique style in helping patients shift into pain recovery.
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