Pain Psychology: A Global Needs Assessment and National Call to Action

Abstract

ObjectiveThe Institute of Medicine and the draft National Pain Strategy recently called for better training for health care clinicians. This was the first high-level needs assessment for pain psychology services and resources in the United States.DesignProspective, observational, cross-sectional.MethodsBrief surveys were administered online to six stakeholder groups (psychologists/therapists, individuals with chronic pain, pain physicians, primary care physicians/physician assistants, nurse practitioners, and the directors of graduate and postgraduate psychology training programs).Results1,991 responses were received. Results revealed low confidence and low perceived competency to address physical pain among psychologists/therapists, and high levels of interest and need for pain education. We found broad support for pain psychology across stakeholder groups, and global support for a national initiative to increase pain training and competency in U.S. therapists. Among directors of graduate and postgraduate psychology training programs, we found unanimous interest for a no-cost pain psychology curriculum that could be integrated into existing programs. Primary barriers to pain psychology include lack of a system to identify qualified therapists, paucity of therapists with pain training, limited awareness of the psychological treatment modality, and poor insurance coverage.ConclusionsThis report calls for transformation within psychology predoctoral and postdoctoral education and training and psychology continuing education to include and emphasize pain and pain management. A system for certification is needed to facilitate quality control and appropriate reimbursement. There is a need for systems to facilitate identification and access to practicing psychologists and therapists skilled in the treatment of pain.

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

“…Health professionals should have sufficient understanding of the biopsychosocial model of pain and how to appropriately assess and refer patients for behavioral health treatment. 252,283 This can be accomplished by improving training and education in pain management 26,284,285 and initiating public campaigns to reduce stigma and enhance public awareness of the biopsychosocial aspects of pain. 286 As noted in other sections of this report, the lack of health insurance coverage for psychological services has also been cited as a significant barrier to adequate pain management (see Section 3.4.2: Insurance Coverage for Complex Management Situations).…”

“…Because of the lack of incentives, not enough providers are trained in behavioral pain management. 281,284 Taken together, the severe shortage of pain medicine specialists and under-resourced and insufficiently trained PCPs treating pain along with insufficient access to behavioral therapists, pharmacists, and other members of the pain management team has hindered the development of efficient, cost-effective health care delivery models to treat chronic pain.…”

Mobilizing the psychology evidence base for the treatment of pediatric chronic pain: The development, implementation, and impact of the Comfort Ability Program

“…Unfortunately, a primary access barrier is that there is a scarcity of pediatric behavioral health providers who have expertise in working with youth with chronic pain. Even when providers are available, there may be patient‐centered barriers such as scheduling conflicts, geographic limitations, and insurance or cost factors to consider 14,15,20 …”

Evidence-Based Psychological Interventions for the Management of Pediatric Chronic Pain: New Directions in Research and Clinical Practice

“…Despite the proven effectiveness of psychologically based strategies for pain, too few pediatric patients referred to psychological services for pain management obtain services due to a lack of available providers, scheduling conflicts, inadequate knowledge of efficacy, and financial or insurance constraints [ 8 , 9 ]. These logistical barriers highlight the need to create models of care that can be flexible in meeting the time, cost, and limited resource barriers that interfere with service acquisition [ 9 ]. Additionally, psychological interventions for pediatric pain must also be packaged and administered in a format that is acceptable, attending closely to the common biomedical biases that may inhibit initial engagement in services.…”