A psychologist with special training in Pain Medicine is a key member of a multidisciplinary pain clinic.  In fact, most definitions of multidisciplinary pain clinics require that a psychologist be an integral part of the team.  This is because social and psychological factors can be the most important issues maintaining chronic pain, and they can be the most important predictors that a patient with a recent injury will progress to have chronic pain.  If psychosocial factors are present, no one can treat the patient successfully without addressing the psychosocial factors.

There is an abundance of quality medical evidence to support these statements, and to support IPCA's approach.  The following studies are a sample of the medical literature which says that psychosocial factors are important to understand, and that treatment that addresses psychosocial factors is effective and necessary:

• A study by Carragee showed that poor coping skills increases - by three fold - the risk that a person will develop low back pain.  (Carragee ET Spine 2004 May 15;29(10):1112-1117)
• A study by Niemisto showed that depression, anxiety, and poor coping skills are more important than physical factors in predicting the outcome of medical and physical therapy treatment of back pain.  (Niemisto L J Rehab Med 2004 May;36(3):104-109)
• A study by Watson showed that depression and anxiety are more important than physical factors in predicting return to work after treatment of back pain.  (Watson P European J Pain 2004 Aug;8:359-369)
• Two randomized prospective studies showed that treatment of psychosocial factors is effective pain therapy - as or more effective than what patient's "traditionally" receive:
  • A study by Linton showed that cognitive behavioral thearapy was more effective than patient education plus conservative medical therapy for back pain - missed work days were much less in the cognitive/behavioral therapy group. (Linton S Spine 2000 Nov 1;25(21):2825-31)
  • A study by Ivar showed that cognitive/behavioral therapy plus excercise was as effective as spine fusion surgery for back pain. (Ivar B Spine 2003 Sept 1;28(17):1913-21)

At IPCA we screen every patient at their consult visit with the physician, and when it appears that psychosocial factors may be imortant we do a multidisciplinary evaluation (provided the patient's health plan covers this service) that includes a physician specializing in pain medicine and a psychologist specializing in medical and health psychology.  Treatment planning takes psychosocial factors into account.  The treatment plan may include individual or group cognitive and behavioral therapy, stress management, coping skills training, biofeedback, and other techniques to address psychosocial factors and enhance the chances of successful treatment.

At IPCA the psychologist is integrated into the treatment team through the shared medical record system, through daily contact with the medical providers, and through regular group interdisciplinary meetings which are attended by the medical providers, physical therapists, complementary and alternative medicine providers, and psychologists.

To our patients:

We certainly believe that our patients have the pain they say they have. We know that when people have had pain for more than 6 months, many parts of their lives may have been affected.  Some examples are work, recreational activities, family activities and relationships, and mood.  We also know that, even if pain has not been present very long, psychological stress can increase the chance that pain will become chronic. 

You may at first have doubts about the medical psychology evaluation, but it has several important purposes. These include the following:

What you can do if your health insurance plan denies coverage for the Medical Psychology evaluation

If your IPCA doctor has requested medical psychology evaluation and testing for you, you may find that your insurance company denies coverage.  The following information is intended to help you understand why insurance companies deny coverage for the medical psychology evaluation, and on page 2 we have included a letter fom us, for you to use when communicating with your health insurance company.

Insurance companies deny coverage for the IPCA medical psychology evaluation and testing for two reasons:

You can help your insurance company understand.

• The medical psychology evaluation, testing and treatment that your doctor has ordered is pain treatment, not "mental health" treatment. Your insurance company may need your help understanding that the IPCA psychologist will be treating a medical condition, not a mental health condition.  A good analogy would be: the counselling patients in cardiac rehabilitation programs recieve - it has nothing to do with mental health - it is about changing behaviors.
• The medical psychology evaluation, testing and treatment that your doctor has ordered is evidence-based medical practice - there is research to show that this evaluation is needed.
  

Your doctor has already made it clear in your clinic notes that you are NOT being referred for mental health services, and your insurance company has these notes.  The information that you are reading right now is available on line to your health insurance plan representative, 24 hours a day.  This is often not enough, but it is all your doctor can do.

Click "Next" below to go to page two of this document to view a letter to an insurance company that has denied coverage for Medical Psychology services.  You can print this letter and use it to help educate your insurance company.