The "future" pain clinician: competencies needed to provide psychologically informed care

Key points

1. 01Current treatments for disabling pain are failing partly because clinicians are not trained to competency in psychologically informed methods, not just because the methods are ineffective
2. 02Patients with chronic pain consistently want empathetic communication, a meaningful understanding of their condition, and individualized treatment aligned with their personal goals
3. 03Core required competencies span five domains: person-centered communication, pain knowledge, clinical assessment, clinical reasoning, and treatment skills including graded exposure and pacing
4. 04Single-case experimental designs (SCEDs) are proposed as the practical tool for clinicians to continuously evaluate whether an individualized treatment is working for each patient
5. 05The authors argue that professional silos must be transcended and a new dedicated "pain clinician" professional category created with competency-based training

How it was conducted

Design

Selective narrative topical review of the psychologically informed care literature for pain

Focus

Patient needs, required clinician competencies, and methods for evaluating individualized treatment outcomes

Framework used

Fear-avoidance model as the core theoretical lens linking psychological factors to chronic pain and disability

Illustrative material

Two fictional clinical cases (Jannick and Susan) used to demonstrate multidimensional assessment and treatment planning

Outcome evaluation method proposed

Single-case experimental designs (SCEDs) with visual analysis, effect size calculation, and inferential statistics

What they found

• Current best-practice guidelines are based on group-average RCT outcomes and provide little information about what works for whom individually
• Screening for psychosocial yellow flags is recommended at the first visit but is infrequently employed, and when it occurs it often has little impact on treatment choice
• Implementation of risk-based stratified care, one psychologically informed method, showed no significant benefit in recent RCTs
• Emotion-focused exposure for disabling back pain and distress was shown to be significantly better than an individual CBT pain rehabilitation program in one cited trial
• The RESTORE trial of cognitive functional therapy showed sustained improvements superior to usual care in primary care settings for people with disabling low back pain
• A SCED study of cognitive functional therapy found that patterns of change were unique to the individual, and suspected mediators (fear and pain control) changed concurrently rather than before improvements in pain and disability

Limitations

• This is a selective rather than systematic review, meaning the literature synthesis may reflect the authors' theoretical perspective rather than a comprehensive evidence base
• No original empirical data were collected or analyzed; recommendations are expert opinion supported by cited studies rather than primary findings
• Competency frameworks described are proposed rather than empirically validated in terms of their effect on patient outcomes
• Implementation of a new cross-professional "pain clinician" training model faces major structural and political barriers that are acknowledged but not fully addressed

Why it matters

For patients

Patients with chronic pain can expect more from their clinician than a structural diagnosis and passive treatments - care that listens to their goals, explains their pain clearly, and coaches behavior change is feasible and evidence-supported.

For clinicians

Clinicians treating disabling pain need specific training in CBT principles, graded exposure, motivational communication, and individualized outcome monitoring - generic professional training is insufficient for this population.

For readers

This paper provides a structured framework connecting what chronic pain patients say they need, the competencies required to meet those needs, and a practical method (SCED) for evaluating whether care is working for each individual.