Pain Psychology: A Path to Creative Expression

The process of earning ABPP board specialization requires a complex elaboration and expression of one’s identity as a clinical psychologist. Once achieved, the ABPP board certification  is a significant distinction. Both authors are ABPP specialists – yet in different specialties – clinical health psychology and psychoanalytic and psychodynamic psychology. We soon realized that the ABPP represented more than a credential of competence in our specialization area of psychology. Application of ABPP principles to our clinical psychology practice provided us with the insight that this credential can inspire creative developments in fields apart from one’s particular specialization. Specifically, the foundational structure of the ABPP provided us with the capacity to contribute to a unique psychological specialty – pain psychology – which is currently not one of the recognized ABPP specialty or subspecialty areas. Nevertheless, we applied ABPP principles to pain psychology – clinically, theoretically, and in professional societies.

Pain psychology is an empirically-validated subspecialty with a tradition of clinical applications and theoretical inquiry. Pain psychology transcends several ABPP specialty areas – i.e., health psychology, neuropsychology, psychoanalysis and rehabilitation psychology. It is increasingly regarded as the standard of care for the emotional distress and quality of life challenges associated with pain disorders and its suffering. It has also become a required screening procedure for invasive pain therapies as per Centers for Medicare and Medicaid Services (CMS) and pain medicine guidelines. It is a formidable aspect of the biopsychosocial model for the delivery of pain care (Cheatle 2016). 

For several decades, we have refined theoretical and practice models for the provision of psychological services to patients diagnosed with chronic pain. Our outcomes have been promising and at times dramatic, and the group of patients benefiting from these services is substantial. In 2021, the CDC estimated the prevalence of chronic pain among US adults was 50 million (Rikard et al 2023). Although pain psychology interventions have been validated, this approach is not widely understood or a part of standard psychological training. Recent public health crises (i.e., the opioid epidemic, pain related suicide) have accentuated the need for psychological interventions as an essential aspect of pain management. There are also problems with equitable access and economic challenges.

The cornerstone of our practice of pain psychology is the biopsychosocial model. This approach supersedes the limitations of the biomechanical model of medicine. Pain is not due to Cartesian dualism. It is a multidimensional experience comprised of sensations, emotions and cognitions integrated by brain processes. The final common pathway is integrative. Pain begins in the soma and culminates in the central nervous system. Chronic pain is ultimately in the brain and highly influenced by psychosocial factors.  

Brain sensitization to pain leads to accentuation of pain perception. Psychological evaluation and intervention can ameliorate this dynamic leading to improved outcomes. This framework is often misunderstood by the healthcare establishment and the general public. We have worked to delegitimize the belief that pain is only psychosomatic. We have devoted ourselves to evaluation, treatment, teaching, supervision, publishing, research and support of professional societies related to the psychology of pain as well as educating the public. Our approach is thoughtful and realistic. We understand that people who are suffering are especially vulnerable. Therefore, interventions based upon evidence guides our work.

We are involved with both the mental health and health care communities. Also, we frequently collaborate with the legal community as patients with pain disorders often have litigation as their condition relates to an event wherein liability is claimed. This latter aspect is challenging and requires that we be mindful of the ethical and legal guidelines of our profession.

An aspect of our role with the healthcare community is our commitment to the American Association of Pain Psychology, a non-profit organization whose core values are to pursue pain psychology treatment with passion, define pain psychology as a primary intervention, to provide ethical, high quality education in pain psychology, and to forge connections to strengthen the practice of pain psychology by developing standardized practice guidelines. Had we not embraced the challenge of becoming ABPP specialists, we would have not been as well-equipped to contribute to the development of pain psychology as an area of practice.

We have been one of the few psychologist members of organizations related to pain medicine where we have promoted psychology, provided training and created relationships with medical colleagues. These organizations include the American Academy of Pain Medicine, Pain Week, and the North American Neuromodulation Society. One author has been a journal reviewer which has provided an opportunity to clarify and educate physician colleagues about issues in psychological practice. The other author has served as clinical faculty for several pain clinics at major academic medical centers.

We hope that our story will inspire psychologists – current and future – who have earned ABPP board certification to recognize that its value is twofold. It is a recognition of one’s specialty and a means of uniquely enlarging the scope of psychological practice to evolving areas relevant to clinical psychology. Specialty boards might encourage this kind of cross-specialization creativity and the ABPP Academies might sponsor interdisciplinary programs. The ABPP is an inspiration for the broadening of psychology and we hope this article will inspire future developments within ABPP to recognize this growing subspecialization. We are hopeful that in the future, pain psychology will be credentialed as a specialization within American psychology.

The opportunities afforded to us by the ABPP distinction are enduring, for which we are grateful.