Dr. Heather K. Vincent, director of the University of Florida’s Human Performance Laboratory in Gainesville, Florida, told Reuters Health by email, “Helping patients cope with pain requires unique skills. The inclusion of a pain psychologist can help patients in ways that are sometimes not measurable in metrics that medicine publishes. A course of life can be changed with the simple act of having a psychologist talk to the patient and show that someone cares about them – and takes the time to see what they need.”
“The driving force for most practitioners embracing the use of psychosocial support for their patients is reimbursement,” said Dr. Vincent, who was not involved in the new statement. “If given the choice to provide services, physicians are more likely to choose the services that reimburse rather than those that do not.”
“Physicians know and generally believe in the importance of psychosocial support but do not have a sustainable mechanism to provide it,” Dr. Vincent said. “This is frustrating for physicians because metrics of performance are typically based on RVUs (relative value units) rather than patient-focused plans which could and should include psychosocial support. I feel that this is the key domino to start the dominos falling into place: to getting these services as part of mainstream medicine.”
Dr. Sean O’Mahony, director of palliative medicine at Rush University Medical Center, in Chicago, who also was not part of the committee, told Reuters Health by email, “Medical providers receive scant training on the effectiveness of psychological modalities for pain. Without knowledge they are unlikely to refer for evidence-based modalities and patients are unlikely to be aware of the effectiveness of these modalities.”
“In spite of the political rhetoric and policy statements on the importance of educating medical providers on pain management, when we surveyed medical house staff at our institution we found that 80% of incoming medical house staff had not had formal education on safe management of pain,” he said. “As a result, we created a dedicated 1-week rotation for all medical interns which includes content on the role of psychosocial assessments and interventions for patients with chronic pain.”
Another constraint, he said, is that “insurance companies will often limit access to mental health providers or require large co-pays but pay for prescription medications.”
“Physicians should familiarize themselves with evidence-based non-medication approaches, including psychological modalities, and find ways to integrate them into the care of patients with acute and chronic pain,” Dr. O’Mahony concluded.