The Missing Piece to Pain Management: Addressing Psychological Factors

By Angela Tague

Traditional pain management methods often don’t address psychological factors. Medications, injections, physical therapy, and surgery create some physical relief, but sometimes, significant pain continues. Pain psychology can help. This cognitive approach to pain management goes beyond biological signals in the physical body to discover the psychological and emotional factors perpetuating discomfort.

The Gap in Traditional Pain Management 

Not all pain management looks or works the same. When you break your arm in a car accident or at work, you contact your healthcare provider to stabilize your body and relieve the physical aches and pains. But what if, after the cast comes off, you still feel pain? 

Traditional pain management clinic protocols usually suggest medications to block biological processes such as throbbing, stinging, or pressure. Or, maybe another surgery is recommended. Sometimes a physical therapist can address misalignments and offer exercises to help.

But there’s a gap in these treatment options. Pain management clinics focus on reducing physical pain. They often don’t look at how you’re feeling emotionally about being in pain, and usually don’t suggest working with a psychologist to understand why you’re suffering. 

Pain is both a physical and an emotional experience.

Understanding Pain Psychology: How Your Brain Processes Pain

When you get injured, the pain receptors in that area of the body send neurotransmitters to your brain to signal that something is wrong. You receive and process these messages almost instantly. Next, you might take action, like moving away from the danger so you don’t get hurt anymore.

Sometimes, the body continues to send these pain signals to the brain, even after the injury has been tended to and healed. This is taxing on our nervous system, in turn affecting us both physically and emotionally.

Pain psychology works to help you regulate your emotional experiences related to pain through self-management techniques such as learning new coping strategies around balanced thoughts, mindfulness, and relaxation.

What Medical Tests Miss: The Psychological Contributors to Chronic Pain 

Medical tests, such as blood draws, X-rays, and MRIs, look at the composition of the physical body. These tests, although effective for treating acute pain situations, do not address the psychological contributors to pain.

In psychology, we recognize and talk about both pain signals (the biological processes) and pain experience (the emotional processes) since the mind and body work in tandem. 

At Idaho Neuropsychology, we focus on reducing your pain experience by identifying the psychological factors that amplify pain perception. 

Pain intensity is influenced by three key factors:

• Thoughts: How the brain interprets pain
• Emotions: Stress, fear, or mood
• Behaviors: Movement, sleep, and daily activity

Here’s a closer look at how these factors often manifest in the mind and body. Your pain is real. Emotional pain is likely exacerbating your physical pain.

1. Threat Appraisal & Catastrophizing

This happens when the pain is interpreted as dangerous. You may ruminate on what you’re feeling, over-magnify the situation, and experience feelings of helplessness. When pain feels threatening, your nervous system becomes more alert, and sensations feel stronger.

2. Fear of Pain & Fear-Avoidance Learning

When pain is interpreted as a threat, you might begin to avoid movement (exercise, hobbies, etc.) or activities in fear of producing more pain. You become hypervigilant, noticing an increase in pain sensitivity and even disability. Avoiding movement often makes pain last longer because the brain never learns that movement is safe again.

3. Hypervigilance & Attentional Bias

If you notice your body interpreting a neutral sensation, such as a hand hold or a pat on the shoulder, as painful, you may be experiencing hypervigilance and attentional bias. Your sensory threshold has decreased, making every little touch feel “off.” And, you might notice yourself paying extra attention to your pain, in anticipation of when it will get worse. Constant body-checking can make normal sensations start to feel painful.

4. Emotional Distress (Anxiety, Stress)

The pain processing systems in your brain are altered by your emotions. When you feel stressed, inflammation in the body increases, motivation wanes, anxiety increases, and you might activate muscle guarding and tension. This is why pain often flares during stressful life periods, even without a new injury.

5. Depression or Low Mood

When you’re feeling depressed, the body’s natural pain-control system lowers. Pain may begin to feel heavier or more exhausting, you have less motivation to engage in activities, and your recovery slows. The brain chemicals that regulate mood also help regulate pain.

6. Loss of Control & Low Self-Efficacy

When pain feels unpredictable or overwhelming, the brain treats it as a bigger threat. If you feel like nothing is helping and you can’t handle your situation, pain intensity may increase because the nervous system is on high alert.

7. Setting Expectations

What we expect changes what we feel. If you expect something to hurt, the brain prepares for danger and increases sensitivity. This happens automatically—not consciously. It’s the same reason placebo effects (and the opposite, called the nocebo effect) are so powerful.

8. Poor Sleep

Sleep and pain are tightly connected. When you don’t get good rest at night, your pain tolerance lowers, inflammation increases, and the nervous system becomes more reactive. In turn, you experience more physical pain, which makes getting quality sleep harder, creating a destructive cycle.

9. Long-Term Stress

If you’re experiencing ongoing stress, the body stays in protection mode to try to keep you safe. Over time, the nervous system becomes extra sensitive, pain alarms trigger more easily, and small pain signals get amplified.

10. What Pain Means to You

Finally, how you think about pain matters. Pain becomes stronger when it feels tied to loss or fear about the future:

“Will I ever get back to normal?”

“What if I can’t work again?”

“My life is changing because of this.”

The brain gives more attention to threats that affect identity, safety, or independence.

How Psychological Assessment Differs from Medical Assessment

At Idaho Neuropsychology, Dr. Melissa Kremer, PsyD, conducts psychological intake assessments for those experiencing chronic pain. This approach focuses on a discussion of your pain and how it affects your daily life emotionally. 

A medical assessment with your primary care physician, medical specialist, or a pain management clinic looks at how the pain is affecting you physically. They might conduct bloodwork or imaging, such as an MRI or CT scan.

To create a comprehensive treatment plan, Dr. Kremer combines what she learns during the psychological intake assessment and the results you’ve received during medical assessments to get a holistic look at how the mind and body are working together as you manage pain. We work alongside your medical team.

Evidence-Based Psychological Approaches to Pain Management 

At Idaho Neuropsychology, we’ll develop a treatment plan together with you, and will consider using one or more evidence-based psychological approaches to reduce your discomfort. Understanding how psychological factors influence your pain gives new avenues for relief.

• Cognitive Behavioral Therapy (CBT): CBT for chronic pain doesn’t mean the pain is psychological or “all in your head.” Instead, it teaches skills that help calm an overprotective nervous system, making pain less disruptive to daily life. This type of therapy can reduce fear around pain sensations, make the brain feel safer, and build confidence in returning to activities you enjoy.
• Acceptance and Commitment Therapy (ACT): ACT for chronic pain doesn’t try to convince someone that pain isn’t real or force positive thinking. Instead, it teaches people how to live a meaningful life even when pain is present, while often reducing how much pain controls daily decisions. ACT focuses on helping people reconnect with what matters most—relationships, purpose, hobbies, work, or personal values—and begin moving toward those things in manageable ways.
• Addressing Trauma’s Role in Pain: One of the most common health issues experienced by people diagnosed with post-traumatic stress disorder (PTSD) or complex post traumatic stress disorder (C-PTSD) is chronic pain. Trauma affects pain perception. The nervous system stays in “alert” mode, which triggers stress hormones, causing inflammation and body sensitivities, amplifying common aches and pains. We can address this type of pain using specialized adaptations of evidence-based treatments such as Cognitive Processing Therapy (CPT), Eye Movement Desensitization and Reprocessing (EMDR), and/or Prolonged Exposure (PE).

Why Choose a Psychologist for Pain Psychology in Boise 

If you’re ready to try a new approach, one that can work in tandem with treatments suggested by a pain management clinic or your physician, Dr. Kremer at Idaho Neuropsychology in Boise has the expertise to help. 

She is extensively trained in all therapeutic processes, with specific certifications in clinical hypnosis and ACT through the Veterans Administration’s rigorous EBP training program.

At the clinic, we offer comprehensive assessments without the need for medical referrals from your insurance provider. You’ll gain new tools and adaptive strategies to manage pain on your timeline. With our self-pay model, there are no insurance pre-authorization delays or session limits. 

At Idaho Neuropsychology, you receive ongoing treatment based on your needs, not insurance caps.

Taking the Next Step: Scheduling Your Pain Psychology Intake Assessment 

If you’re ready to learn how pain psychology can complement your current medical care, we’d love to meet you. We will work together to manage the psychological factors around suffering and improve your daily function. 

Request an appointment through our website or give us a call at (208) 789-0910.