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Psychological Evaluations For Pain Patients

CMPS staff provide specialized psychological evaluations for patients with chronic pain in order to assist in the differentiation of organic/physical effects, psychiatric effects, and pre-existing personality dynamics which may lead to the totality of a chronic pain syndrome.

There are three specific types of psychological or psychiatric evaluations which are performed for patients with chronic pain:

  1. To assist in the appropriateness of spinal cord stimulator placement (or morphine pump placement)
  2. To provide an assessment of the impact of personality factors, psychiatric factors, somatic factors, and motivational factors which bear on the expression of chronic pain symptoms
  3. To provide a measure of current psychiatric, psychological, and somatic/pain distress relative to a specific incident or work-related injury.

Why is psychological assessment of pain important?

Adapted From:

Guide to Pain Management in Low-Resource Settings.
Chapter 13.
Claudia Schulz-Gibbins

People who have painful conditions or injuries are often additionally affected by emotional distress, depression, and anxiety. Chronic pain involves more than the subjective experience of the intensity of pain. The last 30 years, a biopsychosocial model for understanding chronic pain has evolved. According to this model, chronic pain is a syndrome with consequences such as physical and psychosocial impairment. This model contains variables such as central processes on the biological dimension as well as on psychological dimensions, including somatic, cognitive, and affective dimensions.

The cognitive dimension contains how the patient thinks about and attempts to come to grips with the pain experienced. For example, thoughts like “the pain is unbearable” or “the pain will never end” can have an effect on the affective dimension and intensify reactions like anxiety.

Suffering from chronic pain has social consequences, for example, on activities of daily living, family environment, and cultural factors, or it may be affected by previous treatment experiences. Illnesses can be viewed as the effect of the complex interaction of biological, psychological, and social factors.

Emotional and cognitive aspects like anxiety or helplessness and coping with chronic pain can significantly strengthen the pain perception and intensity. Increased pain perception can include emotional components such as despair, sadness, anger, or fear, but it can also be a reaction to impairment due to pain. Correlated with these processes, the cognitive component is the belief that it is not possible to have any relief of pain after unsuccessful treatment. Believing this can, for example, increase feelings of helplessness. The loss of belief in the functionality of one’s own body is experienced as a psychological threat. Very often, the result is a restriction of one’s whole perspective on life through the focus on pain. The consequence is that the person concerned very often retires from physical and social activities. Family conflicts arise because of the feeling of being misunderstood. Self-esteem is affected by the subsequent inability to work. The main focus becomes on consulting doctors to obtain a cure. Increasing consumption of medication is accompanied by fear and apprehension of side effects.

Inactivity because of the impairment by the pain can intensify depressive reactions such as passivity, agitation, lack of sleep, with decreased self-esteem. In a vicious circle, chronic pain can lead to depressive reactions, which influence the perception of and reactions to the pain. Biological processes such as muscle tension can cause pain but can also be caused by increased depression. Depression can lead to more physical passivity, and in consequence, the lessened activity leads to an increase of pain because of degeneration of muscles. All roads, in this scenario, lead to chronic pain.

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