Does this mean my doctor thinks the pain is “in my head,” or I’m crazy?  No.  Chronic pain is real.  Often, it is also very hard to treat, so having a team work with you to treat the pain from different angles can help.  A mental health person can often help you decrease your pain levels, as well as cope better with the pain you have.

How can a psychiatrist help me?  There are several ways a psychiatrist can help.  These include:
1.  Support and problem-solving, as you face this great challenge.  Just having someone to talk to about how you’re doing and what problems you’re facing is helpful.  I also help patients figure out how to deal with problems that come up because of pain.  Pain can affect all areas of your life, including work and relationships.  Talking about these other areas and solving problems that come up in them is helpful.

2.  Teaching skills that can decrease your pain, such as relaxation, visualization and guided imagery exercises.  Hypnosis is sometimes a helpful addition.

3.  Helping you figure out what activity is helpful, and what activity hurts in your present condition.  “Pacing,” which is monitoring your activity level, to do as much as possible while keeping your pain under control, is a helpful skill.  You may learn to replace activities you can no longer do with other ones you enjoy.  Or you might learn to modify activities so you can still do them.  For example, someone who used to like to garden for hours at a time may no longer be able to do that because of pain.  But she may be able to garden over several shorter time periods (pacing), or garden in raised containers instead of her garden (modifying), or take up knitting instead (replacing).

4.  Figuring out with you which of your usual coping skills are helpful to you and which ones may be getting in your way.  For example, some people respond to difficulty by working harder.  This may be helpful if you work hard to find information on your condition, but it could get in the way if you apply this to physical therapy exercises, doing 100 when you were instructed to do 10.  In contrast, some people immediately give up and think the worst will happen to them.  A psychiatrist would help you examine which of your thoughts interfere with functioning, and help you replace them with more realistic thoughts.

5.  Medication.  A psychiatrist is a doctor who can prescribe medication to help decrease pain or increase your ability to handle your situation.  These medications can be helpful even if you don’t have depression or anxiety.  These medications include antidepressants, anti-anxiety medications, anticonvulsants, and others.  Some psychiatrists prescribe narcotics.

6.  Evaluate if you have depression or anxiety that is contributing to your pain.  A psychiatrist can diagnose and treat conditions like depression or anxiety that often come along with pain disorders.  Treatment may include both therapy and medications.

7.  Help you sleep better.  Many patients with pain have a difficult time falling asleep or staying asleep.  Psychiatrists can treat this problem by teaching you skills to help with sleep or by prescribing non-addicting medication if needed.

1.  First, know what body system your pain is in.

Many fields of medicine treat disorders that cause pain.  For example, a rheumatologist would treat arthritis, a cancer specialist would treat cancer, and a neurologist would treat headaches.  You should get a good evaluation, a specific diagnosis, and a plan for treatment from someone who specializes in your particular disease.  This person can follow you over time, or serve as a consultant to your primary care doctor.  The important point is that someone should follow your condition and work with you, in an ongoing way, to monitor how you’re doing and make adjustments to treatment as needed.

2.  Do you need a pain management expert?

There are physicians who specialize in treating chronic pain.  They are in fields such as neurology, anesthesiology, psychiatry, and rehab medicine, but their primary interest and expertise is treating patients with chronic pain.  These practitioners are invaluable in your care, especially if pain is one of your primary symptoms.

If you see your primary care doctor or specialist, and that clears up your pain, that’s wonderful.  But if your pain remains, it’s very worthwhile to see someone who specializes in chronic pain.  Again, this can be a consultation or ongoing treatment.  Chronic pain is often very difficult to treat, so you want to have an expert on your treatment team.

Lastly there are diseases of the pain systems in your body, where pain is not a symptom of something else, but the disease itself is in the systems of your body that control pain.  These are diseases like CRPS (Complex Regional Pain Syndrome, or RSD), central pain, and diseases that cause sensitization of your nervous system.  In these diseases, it’s very important to see someone who specializes in them.

Where do you find a pain management expert?  The best option is to ask your primary care doctor for a recommendation, or to look in an academic health center or in a health system for a pain management center.  Many of the national pain societies also have directories of members where you can look for someone in your area.

Should I See a Pain Management Psychiatrist, Psychologist or Therapist?

First is the pain itself.  Almost everyone has had a bad headache or a twisted ankle, and knows what pain feels like.  But patients with chronic pain have to deal with pain that doesn’t go away – and if you haven’t had this, it can be very hard to understand what that’s like.  Chronic pain, especially severe chronic pain is very, very difficult to experience.  Yes, this experience is a difficult challenge!

In addition to the pain itself, you often experience many, many negative consequences of pain:

•  Pain often affects your ability to work, which may have financial and emotional consequences.  Many people like the sense of purpose and fulfillment, and the social contact that comes from work, and this may be lost.
• Pain affects relationships with family and friends.  At times, you may be depressed and grumpy, which affects those around you.  You may have less ability to do things around the house, or may not be able to go out to do what you did in the past.  Family may becomes as frustrated as you do, if the pain doesn’t improve.  There may be long-term changes in roles, which can be difficult to adjust to.
• Pain affects your leisure time.  Pain may limit your ability to do things you used to like to do, like relaxing or playing with family, socializing with friends, and doing hobbies and favorite activities.  This may come from both the physical limitations of your pain problem, and from the stress and depression that often comes along with chronic pain, just “not feeling like doing anything.”

As we go along, we’ll look at all these aspects of pain.  And there are ways to cope!!  Chronic pain is certainly a challenge, physically, mentally and spiritually, but THERE IS HOPE!!