Should Every Chronic Pain Patient Be Assessed Psychologically

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One of the controversial issues in chronic pain management today is whether every chronic pain patient who is being treated should first receive a psychological evaluation. The arguments against this are practical in nature; there are increased costs associated with this as well as limited resources (access to mental health professionals with pain expertise may be quite limited). Additionally, the fear of communicating to the patient that their "pain is in their head,'' as well as resistance on the part of referring doctors (particularly in settings where referrals are made for specific procedures to be done) are all very practical and significant considerations.

The other side of the argument, however, is based on clinical experience as well as research. Almost all practicing pain management specialists today would agree that there is a high incidence of comorbid psychopathology associated with chronic pain, such as depression and posttraumatic stress disorder. Treating the emotional disorder often helps the pain disorder quite significantly, while not treating the psychiatric disorder hampers improvement of the physical pain, regardless of the medical intervention. Additionally, and quite powerfully, there is a growing body of literature showing that most predictors of treatment success with interventional procedures are psychological, while most predictors of treatment failures are also psychological.

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