December 2, 2015

When physicians at The Johns Hopkins Hospital consider advanced treatments for chronic pain, they often refer patients to the pain rehabilitation psychology team. Nicole Schechter, Megan Hosey and Stephen Wegener are experts on the psychological effects of chronic illness and traumatic injury in the Division of Rehabilitation Psychology and Neuropsychology in Johns Hopkins’ Department of Physical Medicine and Rehabilitation.

Because the various mechanisms involved in chronic pain are so complex, says Wegener, expert psychological assessment can help to maximize the chances for successful treatment.

For example, when pain rehabilitation psychologists evaluate a patient for spinal cord stimulation, opioid therapy or other advanced treatments for chronic pain, they examine the patient’s history of pain, treatments, health and lifestyle. They also look closely at how pain affects the patient’s activity, thinking, mood and behavior.

If a patient being considered for opioid therapy is at risk of misuse or addiction, the psychologist works with the patient and physician to reduce the risks. The pain psychology team not only considers barriers and risk factors, but also identifies and supports the patient’s strengths in managing the pain. The team helps patients identify warning signs of medication overuse or depression as well.

High-risk individuals can continue to see a pain psychologist throughout their treatment to learn alternative pain management strategies, and if warning signs develop, the psychologist can quickly address them. “Just because someone has a barrier to the use of an advanced pain intervention doesn’t mean we won’t work with them,” says Wegener.

Likewise, a psychological evaluation can be beneficial when physicians are thinking about treatment with a surgically implanted spinal cord stimulator, which can be useful in the management of chronic pain. It is important to assess the patient’s expectations for treatment, understanding of the procedure and potential to return to meaningful activity. 

“If the patient’s pain is at eight out of 10 and he or she expects it to drop to zero, his or her expectations may be too high, and the patient may end up disappointed, which can reduce motivation in making life changes after the interventional procedure,” explains Hosey.

For patients with barriers to recovery, such as unrealistic expectations, depression, anxiety or negative thinking, the team can help to maximize the benefits from the pain intervention. “The barriers can be overcome,” Hosey says, “and the patient can still get the intervention. We want to help translate a change in the patient’s pain to improved function and quality of life.”