The Value of Psychological Assessment as Part of Risk Assessment for the Patient with Chronic Pain

An Interview with Geralyn Datz, Ph.D.

Geralyn Datz, Ph.D., is a licensed psychologist, specializing in behavioral medicine. She directs the Pain Management Program at Forrest General Hospital in Hattiesburg, MS. Dr. Datz has been involved in numerous pain research projects and has presented her findings at national meetings.

Evelyn Corsini, MSW:

What led you to work with patients with pain?

 

Geralyn Datz, Ph.D.: I have always had a special interest in pain. I find the intersection of the physical and the psychological really fascinating. I am a native New Yorker and after I completed my undergraduate education I worked in industry research. I returned to school to receive my Ph.D. in clinical psychology at the State University of New York at Stony Brook. I then specialized in Behavioral Medicine, for both my residency and post-doctoral fellowship.

EC: Why did you decide to do research on the role of psychological assessments for patient with chronic pain?

GD: All of the pain literature indicates that untreated or undertreated psychological problems are a predictor of a poor treatment outcome for patients with chronic pain. The literature is calling for clinicians to employ more rigorous screening strategies, especially when opioid treatment is being considered. Some psychological studies indicate that problems like depression and anxiety lead to higher medical noncompliance, lower pain tolerance, and a higher rate of hospitalization.

Unfortunately, not enough research has been done to try to identify the specific psychological factors that could be predictors of aberrant behavior and a poor health outcome in patients with pain. As a mental health provider, I looked at what I could provide for the pain community, and developed a combined psychological and addictionology assessment. Pain patients are referred by their medical providers to me for this assessment.

My research has investigated whether there are elements of the psychological assessment that would also help identify the patient who is at increased risk for opioid misuse.

 

EC: Describe your research so far.

GD: I met with over 100 chronic pain patients referred to me for a psychological assessment. I had them all complete the 24 item SOAPP®-R tool and used their scores as the predictor of opioid risk. I chose this self-report tool as it is content and face valid, and the items are empirically identified as predicting aberrant medication-related behavior six months after initial testing. I hypothesized that specific psychological coping styles and personality characteristics would correlate with high SOAPP-R scores, indicating that the patient was at higher risk.

I conducted two studies with commonly used psychological screening tools, and in each study I found certain factors that correlated with high SOAPP-R scores, indicating potentially higher risk of misuse. For one study, I used a validated personality inventory and in the other I used a screening instrument for personality traits.

EC: What did you learn?

GD: In these studies I found two sets of predictors that correlated with high SOAPP-R scores. In the first study, patients who scored high on depression, anxiety, and negative emotions and increased health anxiety also had high SOAPP-R scores. In the second study, I found that the characteristics of being oppositional and excessively emotional correlated with high SOAPP-R scores. These patients often behave erratically, may frustrate providers, and fail to comply with medical instructions.

EC: What are the clinical implications of these findings?

GD: For one, that certain personality variables are related to potential opioid misuse behavior, although we cannot state which may be driving the other. Secondly, through empirical methods we can identify these patients and design treatments to help them. Negative coping styles and challenging personality traits can be often be remediated by engaging in psychological treatment, so a referral may be wise. For many patients, medical compliance training can be completed within 4-6 sessions. Patients with more pervasive problems may require longer treatment. The main idea is not to exclude people from treatment based on whether they are challenging or not, but to tailor treatment to their needs.

EC: Do you recommend psychological assessment for all chronic pain patients being considered for opioid therapy?

GD: I believe this is ideal. There is so much comorbidity in chronic pain that goes undetected. I urge providers to say to their patients, “I ask all of my patients to have this assessment as part of my treatment agreement with you. I believe it may help with your pain treatment”. Since this is not always possible, and I understand this, prescribing clinicians can refer the patients who they determine are at higher risk, such as those who have elevated SOAPP-R scores, have demonstrated non-compliance or substance abuse. Patients who are overanxious, significantly depressed or those who have a history of adjustment problems, also have increased risk of opioid misuse and can benefit from referral to a psychologist.

Obviously this is not a simple business, as there is a real spectrum of patients whose whole history and way of coping affects their medical treatment plan. It is easier to make the suggestions if the clinician can honestly say, “Based on my evaluation, I have concern about other issues that may affect your medical treatment so I recommend a psychological assessment. I have found this to be very helpful.”

EC: What is the next step in your research?

GD: The next step in the research is to make it less theoretical. I want to correlate health outcomes and medical compliance of these higher risk patients with concurrent psychological treatment.