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

You may be referred to a psychiatrist, psychologist or social worker to help you cope with chronic pain.  Before you run the other way, read on…

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.