The areas of the brain that experience pain and emotion are interconnected. It’s only natural—and expected—for someone’s mental health to worsen with the physical stress of their pain condition, and for their mental health issues to impact their pain.
“You’re kind of hardwired from birth to have a stress reaction to the sensation of pain,” says Kimeron Hardin, PhD, ABPP, FACHP, a clinical health psychologist who practices in the southern California area and co-founder of the American Association of Pain Psychology (AAPP).
In the case of acute pain such as an injury or surgery, that reaction can be useful, because it tells you to slow down and check your body for damage—but what if the pain never goes away?
Research has found that long-term chronic pain changes the nervous system. Psychotherapy can help rewire the brain to ease emotional and sometimes even physical pain, Hardin shares.
Due to the common co-occurence of physical pain and emotional issues, mental health treatment is an important inclusion in pain management. But figuring out where to start finding help can be overwhelming.
Following are guidelines for seeking out mental health treatment when you live with chronic pain.
Finding Someone Who Fits Your Needs
Mental health professionals may have different degrees, specialties, and treatment options.
Therapists and psychologists see patients face-to-face or via telehealth for diagnosis and ongoing counseling.
Psychiatrists or psychiatric nurse practitioners, who also can diagnose mental health conditions, often take a medication-based approach, prescribing and monitoring antidepressants, anti-anxiety medications, and other mental health medications.
Social workers can connect patients with mental health providers in their area through various programs, and some of them offer talk therapy as well.
“Anybody can call themselves a counselor, but you have to be a little bit wary if they don’t have a license or other state credential,” Hardin says. “[Being licensed or credentialed] ensures they’re going to follow certain ethical standards.”
Finding a mental health provider may come down to what’s affordable, available, or required. For instance, those receiving disability assistance may need to see a specific type of mental health professional through their insurance carrier or area mental health services.
Calling your insurance member services can help you find someone in your plan who specializes in or has training in pain psychology or health psychology. Your general practitioner may also be able to provide a referral or point you to the type of provider you need. Mental health providers can also refer you to a different type of provider if needed—for instance, if you start with talk therapy but later determine that medication would help as well.
Many major medical centers have psychotherapists associated with their pain management departments. You can call that department to ask about mental health professionals with experience or training with pain management, Hardin explains. AAPP also offers a directory of pain psychologists.
“A lot of [mental health providers] have bios on Psychology Today. That’s a great way to see people and what they’re putting out there into the world,” says Rachel Zentner, LPC, MSE, a licensed professional counselor who runs a private practice in Wisconsin.
This online resource shows the provider’s education level and publications and provides a sense of who they are and how they practice, with filters for zip codes, insurance plan, disease types and issues addressed, demographics, and more.
Interviewing Providers
Finding the right mental health professional may sometimes feel a bit like speed dating. You need someone you feel comfortable with, because you’re going to share a lot about yourself with this person—and that may involve meeting a few potential providers first.
“One of the most important factors for success in psychotherapy is that you like and trust your therapist,” Hardin says.
The first thing you want to do during your initial appointment is see if you feel a good connection with the provider. Explain why you’re there, and bring a list of questions. Zentner recommends asking these questions, along with any others that are important to you:
Do you have experience treating people with chronic pain?
How do you personally feel about your clients with chronic pain?
What do your treatment plans generally look like?
Will you communicate with my medical providers if I want you to? (Patients can rescind this release of information at any time.)
Can we arrange the room for my best comfort?
“I do have chronic migraine patients, and they need the right lighting. I have low-seeing clients [who need me] to increase the lighting,” says Zentner. “If there’s trauma, they need to sit in certain locations to feel safe. A good therapist will attend to your needs for safety and comfort.”
Many providers offer telehealth services for patients who don’t have access to a local provider or transportation, or who have limited mobility or severe pain that makes it difficult to leave the home.
Building Peer-to-Peer Support
It is a bittersweet experience to meet someone who has walked in your shoes. Pain conditions are isolating. People with pain often don’t share their struggles with loved ones and providers the same way they do with others living with chronic pain. Peer support groups can help fill this gap.
“It’s like people’s shoulders just drop from carrying the weight of stigma,” Zentner says. “You can really laugh about things that people that don’t struggle with chronic pain don’t [understand] and would be horrified to laugh about. There’s a mutual connection in seeing yourself in another person.”
To locate peer support groups, try contacting your local disability resource center or library, and checking with nonprofits and online communities for in-person or online support groups. If you can’t find a good fit, Hardin suggests that those who can start their own peer group.
The U.S. Pain Foundation offers a variety of virtual peer support groups, including national, local, and specialized options. You can learn more by visiting painconnection.org.
Doing the Work
Therapy is not all talk. Your provider should have a treatment plan that involves more than going from session to session. Hardin often gives his patients homework or assigned reading, and then moves on to approaches such as cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT).
CBT focuses on increasing awareness of your thought processes and how they impact your mood or stress response, providing tools such as cognitive reframing, distraction, guided imagery, and meditation to ease anxiety, depression, and other emotional concerns. ACT teaches individuals to accept their thoughts and emotions, emphasizes mindfulness and values, and adds more coping mechanisms to your toolbelt. A new type of therapy called pain reprocessing therapy focuses specifically on reducing pain itself, Hardin shares.
Working with a psychiatrist or psychiatric nurse practitioner to identify and monitor mental health medications that meet your specific needs may be a part of your mental health treatment plan, but practitioners often recommend seeking out talk therapy alongside medications to address thoughts and behaviors on an ongoing basis.
“My patients are often very surprised at how mean they are to themselves and how they talk to themselves,” says Zentner. “We want people to be able to accept what’s happening in the moment, watch what’s happening, and we want them to commit to some type of compassionate behavior toward themselves.”
If you are in therapy but feel stuck with how to consistently follow your treatment plan, Zentner recommends asking your provider about using workbooks or journals to write in or complete exercises, which can help support the treatment plan between therapy appointments.
Emotional pain begets more physical pain, and physical pain can worsen mental health, says Zentner.
A treatment plan for your mental health is an invaluable part of your pain management plan. That starts with finding the right mental health care provider, and putting in the work with their help.
-Ashley Hattle
To learn more about the U.S. Pain Foundation’s Pain Awareness Month initiative, click here.
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