Melanie from Los Angeles: What is a pain psychologist? Do you think that a patient’s pain is in their head?



Your pain is real, of course. You may have a clear medical reason for your pain. Regardless, all pain is highly influenced by many different factors, such as your thoughts, emotions, stress, choices, and behaviors.

A pain psychologist is a doctoral level clinical psychologist who has completed a board certified post-doctoral fellowship in pain psychology.

During an evaluation a pain psychologist will assess for the cognitive, emotional, environmental and behavioral factors in a person’s life that may be serving to worsen a pain, distress, and suffering.

Here are some examples of each:

Cognitive: Thinking that your pain is horrible and worrying that it’s only going to get worse.

Emotional: Feeling anxious and completely at the mercy of pain.

Behavioral: Withdrawing from activity and life, isolating, and staying in bed.

Environmental: Financial stress caused by quitting work or medical bills. Or stress caused by marital problems.

Stress makes pain worse. In a comprehensive assessment a pain psychologist will examine stress in a person’s life, and how the person responds to stress.

Often, treatment involves a two-pronged approach: working to reduce exposure to stressful factors, and also working to help a person change how they are responding to pain and stress (physiologically, cognitively, emotionally, and behaviorally).

It’s important to learn adaptive ways of responding and coping to pain and stress. Our automatic responses are not necessarily helpful for pain management. In fact, our automatic responses can actually make pain worse.

A good psychologist is like a “pain coach.” They will encourage you to set goals for yourself, they will help you develop a behavior plan, and they will teach you important coping tools that will empower you to best manage pain and stress.

This is empowered pain management!



Dorothy from Sacramento: I was in a serous auto accident–and have injured my neck. The surgeons tell me that I have to have a neck fusion (c-4 and c-5) but there’s no guarantee that will rid me of this pain. I worry that the result of the surgery will be less mobility in terms of turning my head etc. I’m thinking about just living with the pain, but I hate what the meds are doing to me. I am happy to be alive but just miserable about my options. What do I do?



Get a second opinion. I always recommend people get a second opinion and here are some guidelines:

Be sure the doctor is an expert in your type of injury. In your case, you don’t just want to see a spine surgeon; you want the opinion of a neck expert.

Make sure the doctors whose opinions you seek are not affiliated in any way. In other words, avoid getting a second opinion from a doctor who works at the same hospital as the first doctor.

When you seek a second opinion, tell the doctor upfront that even if surgery is indicated you will be having the surgery elsewhere . You are simply in his/her office to determine the best course of treatment.

You are simply in his/her office to determine the best course of treatment. Tell every doctor that your preference is for conservative treatment options . Let them know upfront that your goal is to avoid surgery if at all possible.

Let them know upfront that your goal is to avoid surgery if at all possible. Ask your doctors whether physical rehabilitation might be of benefit. Even if other doctors have recommended surgery, you should seek evaluation from a physician who is board certified in physical medicine and rehabilitation. Having the second opinion of a doctor who is most likely to exhaust other treatment pathways prior to recommending surgery will help you feel confident about your final choice — whatever you decide to do.

See a pain physician. You don’t mention whether you are taking opioids, but you state that you don’t like the medications you are on. If you haven’t done so already, seek evaluation from a pain physician (ideally affiliated with an academic pain center).

You may be a good candidate for non-opioid pain medications that likely have lower side effect profiles.

Harness the power of pain psychology to help lessen your suffering. If you feel like you cannot focus on anything except your pain, often worry about it becoming worse, and tend to feel helpless about your pain;, consider working with a pain psychologist. A pain psychologist can help you learn positive ways to direct your thoughts, choices and behaviors. Doing so will enable you to stay centered and grounded in the face of a very challenging situation.

Dr. Beth Darnall is a pain psychologist and clinical associate professor in the Division of Pain Medicine at Stanford University School of Medicine. She has a particular interest in women’s pain issues.

Beth treats patients at the Stanford Pain Management Center in Redwood City, CA. More information about her can be found here and here.

Have a question for Dr. Beth?

Send them to AskDoctorBeth@nationalpainreport.com.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that! It is for informational purposes only and represent the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

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