What Is Pain Psychology? (And Why It's About More Than Pain)
For nearly a decade, I've worked as a psychologist in academic medicine. Technically, I’m a pain psychologist. At Vanderbilt, I'm part of an interdisciplinary pain psychology team. My job is to help people living with chronic pain, complex medical conditions, medical trauma, and the countless ways health challenges can affect a person's life. And while that title is accurate, I've always felt slightly uncomfortable with it. Not because I don't value the specialty. In fact, I think pain psychology offers one of the most sophisticated and compassionate ways of understanding human beings that exists within healthcare. The problem is that the title itself can be misleading. It makes it sound like I spend my days teaching people how to cope with pain. Sometimes I do. But far more often, what starts as a conversation about pain becomes a conversation about life.
Someone comes to therapy hoping to find a way to manage migraines. A few sessions later, we're talking about perfectionism. Someone wants help coping with chronic back pain. Eventually we discover they've spent their entire life believing their worth depends on how productive they are. Someone comes in because of pelvic pain. We end up exploring years of self-abandonment, burnout, relationship stress, or a nervous system that has been running in survival mode for decades. The pain is real. The symptoms are real. The suffering is real. But pain almost never exists in isolation. It exists within a person. And people are wonderfully complex.
One of the things I love most about pain psychology is that it forces us to move beyond simplistic explanations. In medicine, there is often an understandable desire to identify a single cause and a single solution. Find the problem, fix it, and move on. Sometimes healthcare works that way, but most of the time, it doesn't. Particularly when we're talking about chronic symptoms, complex illness, persistent pain, fatigue, digestive issues, autoimmune conditions, sleep difficulties, or nervous system dysregulation. What I've learned from years of working in this space is that health is rarely linear. Our biology matters. Our psychology matters. Our relationships matter. Our habits matter. Our environment matters. Our stress levels matter. Our beliefs matter. Everything is connected to everything else. This doesn't mean symptoms are "all in your head." Quite the opposite. It means that human beings are far more interconnected than we've been taught to believe.
Having spent nearly a decade in academic medicine, I've had a front-row seat to some of the best healthcare available. I've worked alongside brilliant physicians and healthcare professionals who care deeply about their patients. AND I've also seen the limitations of our healthcare system. Most medical systems are designed around efficiency. Appointments are short, specialists focus on their specific area of expertise, and providers are often forced to see more patients in less time. As a result, many people end up feeling fragmented. One doctor looks at the spine. Another looks at the stomach. Another looks at hormones. Another looks at sleep. Another looks at mood. Meanwhile, the person living inside all those systems is left trying to make sense of the whole picture. Many patients come to me carrying years of confusion because no one has had the time or space to help them connect the dots. Often the most healing thing isn't a new intervention. It's finally feeling seen as a whole person.
This is where my work begins to extend far beyond pain. The lens I developed through pain psychology influences how I see every person who sits across from me. Whether someone is struggling with chronic pain, burnout, anxiety, relationship difficulties, life transitions, grief, perfectionism, or simply feeling disconnected from themselves, the questions I ask are often the same: What happened to your nervous system along the way? What adaptations helped you survive? What patterns made sense at one point but may no longer be serving you? What is your body trying to communicate? Where are you living out of alignment with your values? What would healing look like if we stopped focusing exclusively on symptom reduction? These questions are relevant to everyone. Not just people with pain.
Over the years, my work has also been shaped by mindfulness, contemplative traditions, health psychology, and emerging research on psychedelic-assisted therapies. While these fields differ in many ways, they share something important: They all encourage us to move beyond the idea that humans can be understood through isolated symptoms alone. They invite us to become curious about the larger systems at play. The body. The mind. The nervous system. Relationships. Meaning. Purpose. Identity. Healing often happens when we begin reconnecting these pieces rather than treating them as separate.
People often come to therapy wanting strategies. And strategies can absolutely help. But underneath the request for strategies is usually something deeper. They want relief. They want understanding. They want to stop fighting themselves. They want to understand why they keep getting stuck in the same patterns. They want to feel more at home in their own lives. In my experience, the most meaningful work happens when we move beyond asking, "How do I get rid of this symptom?" and begin asking, "What is this experience trying to teach me about myself?" That's where transformation tends to happen. And that's why, despite spending nearly a decade as a pain psychologist, I don't think my work is ultimately about pain. I think it's about helping people understand themselves more fully. Pain simply happens to be one of the many doorways that brings people there.
