Patient Psychology and Opioid Therapy: Are You Assessing the Risk?

It turns out that psychological factors strongly correlate with prescription for opioids and also for opioid dose. Some of those factors are depression, anxiety, post-traumatic stress disorder, and history of substance use disorder.  So a person’s history and also their current psychological make-up influence not only pain, but also pain treatment pattern, specifically with respect to opioids. As a clinical psychologist, I’m always interested in helping people understand the interface between psychological factors and opioid use, and to do that we really begin with understanding more about pain. When we think of pain, we think of it as just being a sensory experience, but it’s also an emotional experience.

How we feel emotionally is going to influence what we feel at the sensory level--sensory perception--and that really sets the stage for understanding that psychology is built into the definition of pain. A patient’s psychological make-up is not necessarily causing their pain problem, but a lot of research tells us that our emotions influence how much pain we do feel, and that’s where we have control. If we can focus on better managing some of the thoughts and the feelings, our behaviors, and our daily choices, then we can better control pain and rely less on pain medication.This is hard, given that physicians and prescribing providers don’t necessarily have the time to really vet all the psychological factors that might be feeding the pain experience, but with an understanding of how these factors influence sensory perception, the prescriber can be broadly monitoring their patients for these issues. It’s also incumbent upon the prescribers to provide patients with resources to education, so that they can begin to understand how these pieces fit together themselves. And lastly, it’s important to refer people to a pain psychologist, to a psychotherapist, or other specialist who can helping patients acquire the skills to better manage some of the factors that influence the pain experience.