I want to give you an understanding of what I do as a pain psychologist. Now, that is a big topic for a single post! So I will talk more directly about what I see happening in the medical field and how I help patients with their pain management.

Let’s start with what I discovered by listening to people with pain. They are worried about what is causing the pain, and often their pain management team doesn’t provide them enough time to address those worries. They’ve often been told things in medical terms that are difficult to understand in the 5-10 minutes they’ve had with their provider. Even if the provider gave them more time, he/she was usually not good at explaining the plan of care or the diagnosis. I find that patients were often TOLD what is wrong with them, sometimes before they were even examined or questioned about their experience.

Weird question: who is the expert on your body? Well, you are of course! So why aren’t your medical providers listening to you? Also, why aren’t these caregivers making sure you feel comfortable with the plan and understand your options? From my experience with spine surgeons, physiatrists, and other interventional / non-interventional pain providers, some have good organized plans and some have completely illogical plans of care that are equivalent to “we will inject you here and if that doesn’t work, we will inject you over here” with no consistency in the process or connection to the symptoms you have (now that is frustrating!).

When I started my current job 19 years ago, I was blessed with a fantastic interventional pain provider who wanted me to learn his diagnostic / therapeutic workup plan so that I could make sure our patients were involved in the process of their own treatment (he was one with a great organized and thoughtful workup plan). He also had me consult with every patient he saw for the first 2 years of my practice. This allowed me to see who was doing well and who was struggling, and also allowed me to determine the common needs of pain patients.

What I found was that most people had a limited understanding of what was going on in their body and how the treatment was going to make it better. The best treatments help your body heal itself; your body does the hard work! I also realized that what I had learned about all the techniques of coping with pain during my training were largely worthless for people coping with severe daily pain. I learned more from the people I was working with than I have ever learned from a textbook or a professor. Because I was able to see those people who were coping well with a serious pain condition, I learned from the true EXPERTS — those dealing with it every day. These people educated me. I learned by listening to them.

In the end, I determined my role was to do whatever was needed to help that patient sitting in front of me. Often times they did not need an intensive evaluation and psychological assessment, they needed someone who would help them understand what was going on with their body. In any given visit, I may be asked questions about injections, medications, why physical therapy is so painful, and many times needed to address the person’s fear that their pain will never go away. I have a whiteboard in my room and we (mostly me but sometimes the patients) fill it up during the course of the visit to work thru questions and use pictures to help the information sink in.

A side comment: I was recently interacting with my psychologist colleagues and I was amazed that they do not use whiteboards. I told them point blank that they need to get one to draw fun stuff because a picture is worth a thousand words (yes, I wish I had a whiteboard right now because I am nearing 1,000 words). My patients will often take a picture of the whiteboard to help them remember what it was we covered.

Now the point of all this is we need to tailor what we do to what the patient and their family needs. My final comment about my job is that I have FUN with the people I see. My staff refers to my therapy room as the “feel good room” because there is usually a great deal of laughing, joking, and general fun occurring during my visits. That is a requirement in my world because chronic pain sucks and one of the best ways to get through it is HUMOR.

I hope this gives you a little idea of what I believe a pain psychologist does. We should be doing what you, the person with pain, needs us to do. We should also have fun doing it! Back to opioids with the next post, stay tuned.

PS: Thanks to all the wonderful and truly enjoyable people who have taught me over the years about what it means to cope with crappy life experiences like chronic pain.