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Hospital and Physician Update

September – October 2020

Guest column from J. Bruce Hillenberg, Ph.D.
Pain psychologists can help patients cope more effectively with pain

J. Bruce HillenbergAcute and chronic pain challenge patients and health care providers across all medical specialties. To help meet this challenge — and achieve effective, value-based pain care — pain psychologists recommend an integrated approach.

To facilitate integration, pain psychologists collaborate with their health care partners (such as physicians, nurses, pharmacists, physical and occupational therapists, social workers and integrative medicine staff) and patients to identify psychosocial factors that trigger or amplify physical pain. They also screen and treat patients at risk for misuse or abuse of pain medication. This collaboration can help pediatric, adult and older adult patients who are at high risk for elevated procedural and or post-surgical pain, such as those with psychological distress and fear or chronic pain. 

For acute pain, a variety of distraction and relaxation strategies, coupled with counseling on realistic expectations, can have a direct impact on the neurobiology of pain perception, thereby improving tolerance, coping and pain management. When patients realize that they can influence the perception of pain, they recognize the power that comes from coping strategies and self-soothing techniques. For chronic pain, pain psychologists use a variety of treatment strategies to help patients overcome pain when emotional factors are the primary driver — or reduce the intensity of the pain, expand functional restoration and improve quality of life when nociceptive pain (pain from physical damage) or neuropathic conditions drive the pain.

Factors influencing pain
Pain psychologists understand that pain is a biopsychosocial condition, and effective treatment must address suffering. Also, they recognize that an individual’s cognitive and behavioral responses strongly influence the impact pain has on her or his daily life. Pain science tells us that all pain is real and that multidimensional factors interact to influence the presence, intensity and impact of pain, including:

  • Genetic predisposition to heightened pain amplification
  • Nociceptive and neuropathic disease
  • Centrally based psychophysiological activation and amplification
  • History of psychological trauma
  • Family history of pain
  • Patient beliefs about the cause and seriousness of the pain
  • Fear of pain and reoccurrence
  • Patterns of behavioral avoidance
  • Grief and emotional distress
  • Sleep quality
  • The response of significant others
  • Cultural models for the expression of pain
  • Mental health and substance use history

Pain psychologists can help their health care partners sort through this maze of potential contributing factors and collaborate on an integrated treatment plan to improve outcomes. This is true for both elevated acute pain and chronic pain. Research demonstrates that integrated, interdisciplinary pain care produces superior outcomes. Yet, as the stated in the National Pain Strategy released by the U.S. Department of Health and Human Services in 2016, champions of integrated care must actively work to remove the systemic, financial, insurance and practice barriers to value-based pain care. Pain psychologist can be good partners in this effort.

Questions to consider

Some of the questions on the mind of a pain psychologist when she or he meets a patient for the first time include:

  • Is the patient’s fear and anxiety increasing the likelihood of elevated pain?
  • How is the person’s emotional history, awareness and integration influencing pain?
  • How open is this person to learning pain science and improving self-management?
  • Are this person’s coping responses improving or decreasing quality of life?
  • How frightened is this person of movement-related pain?
  • Is the person over-reliant on medication and medical procedures for the treatment of pain?
  • How confident is this person that they can live a good life despite the experience of chronic pain?
  • How willing is this person to exercise and engage in activities despite pain?
  • Do the responses of significant others increase or decrease the impact of pain on the patient?

Treatment is most successful when a patient with complicated acute or chronic pain welcomes the guidance of a pain psychologist. The patient’s physician can play an important role in encouraging a patient to be open to such guidance. With appropriate patient motivation, pain psychologists — working with other members of the integrated care team — can guide the individual to:

  • Understand pain.
  • Improve awareness of the link between emotion and pain.
  • Express feelings.
  • Reduce fear and avoidance behaviors.
  • Stop catastrophizing.
  • Learn to relax and reduce physical tension.
  • Increase mindfulness.
  • Decrease misuse or abuse of medication and rebuild confidence in one’s body.

We’ve found that physicians treating pain can improve the value of patient care and increase patient satisfaction with their practice when they enlist the help of psychologists who have developed competence in pain science and care. To help promote this collaboration and improve competency in pain psychologists across Michigan, the Michigan Psychological Association has formed a workgroup called the Pain Psychology Network. To learn more about this network, contact me at

J. Bruce Hillenberg, a member of the American Board of Professional Psychology, is board-certified in clinical health psychology and president of the Midwest Pain Society. He retired as chief of Pain Management Services for Beaumont Health in June 2019. Hillenberg currently has a part-time private practice in Bloomfield Hills, treating patients with chronic pain, depression and anxiety.

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