Psychological Characteristics of Chronic Pain: a Review of Current Evidence and Assessment Tools to Enhance Treatment
Purpose of Review
The complicated nature of chronic pain involves an interplay between psychological and physical factors, often resulting in increased emotional distress and reduced quality of life. This review is designed to help the medical practitioner who is working with chronic pain patients to be aware of psychological assessment techniques that can add to comprehensive patient understanding and more effectively guide treatment. Enhanced ability to assess and understand the emotional life of the chronic pain patient provides a basis for intervening and treating more successfully.
There are a broad range of assessment techniques, some of which require a background in psychology and some that do not, that can identify psychological differences in chronic pain patients and serve to guide intervention strategies. Chronic pain is often comorbid with depression, anxiety, catastrophizing, and various ineffective coping strategies. Some patients, however, have demonstrated more adaptive and effective strategies for cognitively and behaviorally coping with pain and normalizing their lives. Proper assessment enables the individualization of treatment to overcome and/or build upon each patient’s psychological frame of mind to maximize the potential for effective functioning.
The use of standardized and documented psychological assessment techniques can lead to a better understanding of chronic pain patients and contribute in ways that can enhance response to medical treatment and improve quality of life. It is recommended that certain psychological tools be included to supplement the medical assessment of patients who have chronic pain. A basic assessment can include a short psychological-based clinical interview along with brief measures of depression, anxiety, and coping strategies. It is also recommended that the pain physician have access to professional psychological practitioners as a resource for more complicated assessments and psychological intervention services.
KeywordsPsychological assessment Anxiety Depression Catastrophizing Coping strategies Cognitive-behavioral therapy
Compliance with Ethical Standards
Conflict of Interest
Rhondene M. Miller and Ronald S. Kaiser declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 5.Holmes A, Christelis N, Arnold C. Depression and chronic pain. Med J Aust. 2012:10–7.Google Scholar
- 6.• Turk DC, Fillingim RB, Ohrbach R, Patel KV. Assessment of psychosocial and functional impact of chronic pain. J Pain. 2016;17(9):21–49. A good source of additional available physical, psychosocial, and cognitive/emotional functioning and functionality assessment measures for use with pain patients. CrossRefGoogle Scholar
- 9.•• Borkum J, Wootton J. Psychosocial assessment of chronic pain. In: Bajwa ZH, Wootton R, Warfield CA, editors. Principles and practice of pain medicine. 3rd ed. New York: McGraw-Hill; 2017. A thorough examination of assessment tools available for use with pain patients. Google Scholar
- 11.Surah A, Baranidharan G, Morley S. Chronic pain and depression. Contin Educ Anaesth Crit Care Pain. 2013;46.Google Scholar
- 12.•• Turk D, Okifuji A. Psychological aspects of chronic pain. In: Bajwa ZH, Wootton R, Warfield CA, editors. Principles and practice of pain medicine. 3rd ed. New York, McGraw-Hill; 2017. A comprehensive review of additional psychological aspects of pain including pain conceptualization models, behavioral/cognitive/affective factors, and pain patient heterogeneity. Google Scholar
- 14.Vowles K, Zvolensky M, Gross R, Sperry J. Pain-related anxiety in the prediction of chronic low-back pain distress. J Behav Med. 2004;27(1):77–89. https://doi.org/10.1023/b:jobm.0000013645.40613.42.CrossRefPubMedGoogle Scholar
- 17.Arnow BA, Blasey CM, Constantino MJ, Robinson R, Hunkeler E, Lee J, et al. Catastrophizing, depression and pain-related disability. Gen Hosp Psychiatry. 2011;33(2):150–6. https://doi.org/10.1016/j.genhosppsych.2010.12.008.CrossRefPubMedGoogle Scholar
- 19.Bernini O, Rivas T, Berrocal C. The chronic pain acceptance questionnaire: preliminary evidence for the predictive validity of patients’ subgroups. Journal of Evidence-Based Psychotherapies. 2014;14(1):3.Google Scholar
- 24.Williams N. Phq-9. Occup Med (Lond). 2014;64(2):139–40. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.CrossRefGoogle Scholar
- 27.Beck A, Steer R. Beck anxiety inventory manual. San Antonio: The Psychological Corporation; 1993.Google Scholar
- 34.Jimenez SC. Using the Millon Behavioral Medicine Diagnostic (MBMD) to predict outcomes of spinal cord stimulation for the treatment of chronic nonmalignant pain for patients who identify as white. Chicago: Adler School of Professional Psychology; 2013.Google Scholar
- 36.Ben-Porath YS, Tellegen A. Manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press; 2008.Google Scholar
- 37.Greene A. The MMPI-2/MMPI-2RF: An interpretive manual. 3rd ed. Boston: Allyn & Bacon; 2011.Google Scholar
- 40.Muller R, Gertz KJ, Molton IR, et al. Effects of a tailored positive psychology intervention on well-being and pain in individuals with chronic pain and a physical disability: a feasibility trial. Clin J Pain. 2016;32(1):32–44. https://doi.org/10.1097/AJP.0000000000000225.CrossRefPubMedGoogle Scholar
- 41.Peters ML, Smeets E, Feijge M, van Breukelen G, Andersson G, Buhrman M, et al. Happy despite pain: a randomized controlled trial of an 8-week internet-delivered positive psychology intervention for enhancing well-being in patients with chronic pain. Clin J Pain. 2017;33(11):962–75. https://doi.org/10.1097/AJP.0000000000000494.CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Seligman MEP. Flourish: a visionary new understanding of happiness and well-being. New York: Free Press; 2013.Google Scholar