Pain is mediated by the brain and we know that emotions and thoughts significantly alter the sensation of pain.  This is a physiological fact.  Therefore, it is very important that a pain physician address psychological issues.  If our evaluation reveals psychological “barriers” to recovery, we may institute specific tests and/or refer the patient to a specialist for evaluation and/or treatment.  In this day of enlightened thinking, psychological therapy does not mean someone is “crazy.”  Some therapies, such as biofeedback and hypnosis, represent another modality to use in combination with medications, physical therapy and injections to decrease pain and improve function.