When to refer to a psychologist

Patients whose pain experience or pain management is influenced by complex psychological or social factors may benefit from formal psychological intervention.

All healthcare practitioners should assess the psychological impact of pain and psychological factors that may be aggravating or relieving the patient’s pain experience; see Assessing a patient with pain. Refer the patient to a psychologist if:

  • the pain is significantly impacted by the patient’s beliefs, worries, responses, mood state or interpersonal relationships
  • the pain is impacting on mood and behaviours in a markedly negative way
  • psychological factors are impeding treatment adherence
  • basic psychological techniques have not been sufficiently helpful.

When referring a patient for psychological intervention, emphasise that the use of psychological techniques does not mean that their pain is not real or not being taken seriously. Instead, position pain as a complex problem that requires a multidimensional approach. This is particularly important for patients with chronic pain.

Refer patients to a local, community-based psychologist or a multidisciplinary pain service, depending on the complexity of the patient’s presentation1. Where possible, refer patients to a psychologist that has experience in pain management and understands the sociopsychobiomedical factors that influence it2. Funded programs for psychological services may be available and should be explored.

Patients can be referred for individual sessions or group-based programs. The most disabled or distressed patients may be best managed in a multidisciplinary pain service, typically as part of a high intensity group-based program.

The number of sessions required is often proportional to the amount of distress and disability experienced by the patient. Most patients require between 5 and 20 sessions initially, and follow-up sessions after 3 to 12 months are often useful.

If more than one healthcare provider is involved in a patient’s care, they should share a common understanding of the presenting issues, maintain regular communication between providers and deliver interventions in a coordinated way. See The role of healthcare providers in chronic pain management for further advice.

1 Refer children to a psychologist with paediatric experience appropriate to the child’s developmental level.Return
2 The Australian Psychological Society provides contact details for psychologists in Australia [URL]. The Australian Pain Society provides contact details for pain treatment facilities in Australia that offer psychology services [URL]. It also provides the contact details for some psychologists who are members of the Australian Pain Society and therefore have an interest in pain management [URL].Return