Psychological Assessments and Pain Care Planning: Use & Coding Considerations

According to The National Institute of Mental Health, “People with other chronic medical conditions have a higher risk of depression.”1  To that end, there is a high probability that any person with a chronic pain condition has a concomitant psychological disorder, most notably depression and/or anxiety. The relationship between chronic pain and depression/anxiety is well established. The causal link between pain and these disorders can point in either direction and over time may form a positive feedback loop between these two elements.

Screening tools are available that will aid in the detection of potential depression/anxiety, and when indicated, a referral may be most appropriate for more extensive evaluation and treatment. In addition, lesser psychological factors such as catastrophizing and fear avoidance behavior may interfere with a patient’s recovery and should be recognized by the clinician. Recognizing indicators of patient psychosocial health behavioral factors can affect a patient’s recovery and/or compliance with treatment and may decrease the risk of developing chronic illness/pain. Tools such as the PROMIS-29, Pain Catastrophizing Scale, and PHQ-9 depression scales are examples.

• The clinically-validated PROMIS-29 multidimensional pain scale is used to detect changes in pain, anxiety, depression, physical function, sleep and quality of life.
• The Pain Catastrophizing Scale is broken into three sub-scales being magnification, rumination, and helplessness. The scale was developed as a self-report measurement tool that provided a valid index of catastrophizing in clinical and non-clinical populations.
• The PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression.