At what stage in pain management should psychological treatment be introduced?
The basis for referral of a patient for a pain psychology evaluation is the clinician’s judgment that psychological factors are implicated in the presentation of the pain and the suffering. It should be emphasized that not all patients with pain have psychological comorbidity and so the determination by the pain practitioner is individual and on a case-by-case basis. If a patient does not seem to be benefiting from pain medicine treatment, if there are questions about serious emotional distress, if there are concerns about medication abuse, or if a history of trauma is known or suspected, a psychological referral is in order. Additionally, third-party insurers require certain invasive pain therapies—such as spinal cord stimulation—provide psychological clearance as to the patient’s suitability for the procedure.