MD Anderson Cancer Center

Grace Kao, Ph.D., ABPP is a board-certified pain psychologist and associate professor at The University of Texas MD Anderson Cancer Center. She is also the founding psychologist of the interdisciplinary chronic pain clinic at Texas Children’s Hospital and former faculty clinician at Baylor College of Medicine. Professionally, she spends her time supporting patients and families who are navigating the journey of chronic pain, providing instruction and consultation and advisory board service in pain psychology, and writing about health and healing.

Recognizing Grace Kao’s extensive expertise in pain psychology at MD Anderson Cancer Center, this exclusive feature offers invaluable insights into the challenges of integrating behavioral health into pain management and strategies for fostering a patient-centered, multidisciplinary approach to enhance care and improve outcomes.

When asked about motivations for entering the field of pain psychology, I often begin by describing a fascination with how closely in-sync our minds and bodies work. Indeed, over the past decade, my career as a pain psychologist has centered largely on the close integration of behavioral health and pain medicine. When I joined MD Anderson Cancer Center as a faculty clinician and pain psychologist just over a year ago, it was with an eagerness for the opportunity to help support a more integrated, patient-centered approach to pain care — one that considers not only the biological dimensions of the pain experience but also the emotional, cognitive and behavioral factors that shape how our patients experience and cope with pain.

Developing and promoting a multidisciplinary approach to healthcare service delivery often requires a multi-step, multi-pronged approach. Though addition of clinical programming may be the most prominent pathway for service expansion, strategic integration of a behavioral health perspective ideally occurs in multiple areas (e.g., clinical, administrative, research and educational). Expanding and enriching the Pain Medicine Department’s services with psychology support has included work in clinical integration, quality improvement research and both clinician and patient education.

Clinical considerations

Clinically, by building upon the foundations laid by past pain psychologists and others, the team and I have worked to develop frameworks for greater pain psychology service availability and place additional focus on psychosocial outcomes. One helpful endeavor has been developing and implementing a process to incorporate clinical patientreported outcome (PRO) questionnaires that assess for functional (e.g., pain interference, activity engagement) and psychosocial (e.g., distress about pain, depression, anxiety) factors directly into the electronic medical system for more comprehensive monitoring and assessment. Noting and discussing these psychosocial outcomes over time helps our team introduce and present pain as a multifactorial, biopsychosocial experience. Additionally, the team has continued to identify areas for programmatic growth. Excitingly, I am in the process of developing a framework for offering group courses covering pain management strategies that will allow greater patient access to these important skills.

Research considerations

When I started in my current role, one key question I wanted to clarify to better understand pain psychology needs was how familiar patients might be with non-pharmacological pain treatment modalities upon referral to our program. To assess this, we implemented a quality improvement research initiative to survey new patients regarding knowledge of chronic pain treatment modalities. Soon, we will be analyzing this data to determine how to support greater introduction of and engagement in multidisciplinary pain treatment, including with behavioral health.

Educational considerations

To support clinical and research efforts, building educational programming that promotes behavioral health has also been a significant goal. Towards that end, we have integrated pain psychology topics in the departmental training curriculum for medical fellows, started a health psychology externship, and developed a wellness didactics and experiential series covering the mind-body connection, open to all department members. We will also be looking to provide more comprehensive pain and pain psychology education to our patients through didactic classes and with input from our quality improvement initiative. These educational offerings aim to support the program in providing additional exposure to the mind-body modalities extended to patients as well as promote a focus on well-being amongst the team.

Benefits of integrated psychology care

As we continue with this integration work, I am consistently reminded of the therapeutic role pain psychology plays in providing time, space and environment for patients to form therapeutic connections with the clinical team. Unlike brief procedural encounters or medication management visits, psychological care often allows for extended time and continuity. In these sessions, patients are invited to share experiences, values, fears and hopes—elements that are essential to healing but often fall outside the scope of traditional medical evaluations. This process naturally creates a space where rapport can flourish; and research consistently shows that strong therapeutic alliances are linked to improved health outcomes—including reductions in pain intensity, disability and emotional distress. For pain psychology to continue being recognized as a valued arm of pain management, this promotion of patient-centered care should serve as a strong driving force for continued pain psychology and behavioral health support.

Overall, as we look to better integrate pain psychology into our current pain management practice, we strive to develop not simply an added modality, but a system of care that recognizes a more comprehensive and humanistic perspective of the pain experience.