The economic utility of clinical psychology in the multidisciplinary management of pain

Chronic musculoskeletal pain is the leading sources of disability worldwide, imposing an enormous burden to both societies and healthcare systems (Vos et al., 2012). Direct medical expenses and indirect costs due to losses in work productivity exceed $200 billion in the US (Ma et al., 2014; Park et al., 2016) and are a major source of concern in Europe (Breivik et al., 2013). Mean per capita costs vary from country to country (see Table 1), but are estimated to double the expenses for the care of matched controls (Gore et al., 2012; Hong et al., 2013). Notably, their impact is directly linked both to the severity of the condition and to the presence of mental comorbidities, and can be inflated by concomitant opioid abuse (Baumeister et al., 2012; Manchikanti et al., 2013; Stockbridge et al., 2015; Rayner et al., 2016).

In the last decades, the biopsychosocial model has attempted to answer to the growing imperative need to identify the best practices for the prevention and treatment of chronic pain and related conditions. Scientific research shows that clinical psychology plays a key role within the multidisciplinary approach that is increasingly being suggested for pain management. Its added value is revealed not only by the improvement of the patient experience, but also with regards to economic savings and cost reduction of his care, which is an issue on which modern health services base their strategic decisions. These benefits have been corroborated by studies addressing psychological treatments for chronic musculoskeletal pain, which will be discussed later. However, we argue that the work of clinical psychologists can improve the economic sustainability of chronic pain management in all the stages of the care, from the assessment phase to the rehabilitation period, providing a differentiated contribution depending on the treatment course of the patient (i.e. conservative treatment, surgical intervention). In particular, we suggest that the cost-effectiveness of chronic pain management can be enhanced employing a psychometrically sound, computerized and integrated assessment. After the diagnostic process, psychological techniques and interventions can be useful for pain management or, in case of surgical interventions, to enhance their outcomes.