The Psychological Assessment of Patients with Chronic Pain

There is strong evidence that the biopsychosocial model does not apply only to dysfunctional patients with chronic pain, but rather represents the inherent nature of pain. Research has determined that psychological tests are scientifically as valid and reliable as medical tests with regard to diagnostics and predicting a patient’s response to treatments for pain. As many payers and guidelines now require psychological evaluations prior to authorizing certain treatments for pain, pain clinics increasingly use some form of psychological assessment. While there are a large number of psychometric questionnaires used to assess patients with chronic pain, only a few have undergone the rigorous process required to become standardized tests, and these are reviewed. Both evidence and opinion are converging on a set of psychosocial variables that should be assessed when treating patients with chronic pain, and these can all be organized within a biopsychosocial “vortex” paradigm. A standardized method of psychological assessment can identify patients who are at low, moderate, and high risk, and this is illustrated with three case vignettes.