Psychological Evaluation in Interventional Pain Practice

Two phenomena currently characterize the field of pain medicine. First is the dramatic rise of interventional pain practice. Invasive, nonsurgical procedures are playing an increasingly prominent role in the treatment of chronic pain. ¹ Simultaneously, research points out how psychologically and behaviorally complex are the patients who present to pain physicians. Recent informal studies indicate that an alarming proportion of patients in carefully managed practices are abusing narcotics or other substances and are escaping routine detection. ² Depression as a consequence of chronic pain is considered normative. ³ Demoralization and passivity typically characterize this population, which increases the implicit demand on physicians to provide cures. Physicians, and particularly their staffs, complain of the high incidence of personality disorders in their practices. The physicians who care for people with chronic pain often find themselves feeling overwhelmed and at a loss regarding how to provide compassionate care while developing and protecting their practices and finding a sense of satisfaction in their work.