Chronic pain is a complex experience that extends far beyond physical discomfort — it shapes emotions, relationships, sleep, identity, and quality of life. At Sweetwater Pain & Spine, pain psychology is not an add-on but a core component of comprehensive care. Our psychologist works alongside our physicians to treat the whole person, not just the pain signal.
What Is Pain Psychology?
Pain psychology is a specialized field of clinical psychology focused on the assessment and treatment of chronic pain and its associated psychological, emotional, and behavioral consequences. It is grounded in the understanding that chronic pain is never purely physical — the nervous system, brain, thoughts, emotions, and behaviors all play powerful roles in how pain is experienced, amplified, or managed.
Unlike mental health treatment for psychological disorders, pain psychology does not suggest that your pain “is all in your head.” Instead, it recognizes that the brain processes every pain experience, and that psychological tools can directly influence those brain processes — reducing pain intensity, improving function, and helping patients reclaim meaningful, active lives.
At Sweetwater Pain & Spine, our psychologist works directly alongside our pain physicians in a true collaborative care model. Psychological care is initiated early — not as a last resort — because the evidence is clear: integrated care produces significantly better outcomes than medical treatment alone.
The Mind-Body Connection in Chronic Pain
Modern pain neuroscience has fundamentally changed our understanding of chronic pain. The brain is not a passive receiver of pain signals — it is an active processor that can amplify, dampen, or even generate pain based on context, emotion, memory, expectation, and attention. This is not weakness; it is normal nervous system biology.
When pain persists, the nervous system can become sensitized — a process called central sensitization — where the “volume dial” for pain is turned too high. Stress, anxiety, depression, catastrophizing thoughts, poor sleep, and social isolation all feed this sensitization cycle, making pain worse and recovery harder. Conversely, psychological treatment directly targets these neural mechanisms, providing real, measurable changes in how the nervous system processes pain.
Understanding this connection is empowering: it means you are not helpless against chronic pain. With the right tools, taught by a skilled pain psychologist, patients can reshape their pain experience from the inside out.
Evidence-Based Therapeutic Approaches
Click any approach to learn more about what it involves and how it helps.
› Cognitive Behavioral Therapy (CBT) The most extensively studied psychological treatment for chronic pain
Cognitive Behavioral Therapy (CBT) is the gold-standard psychological treatment for chronic pain, supported by decades of high-quality research. It is based on the principle that thoughts, feelings, and behaviors are deeply interconnected — and that changing unhelpful thought patterns and behaviors can directly reduce pain, improve function, and enhance quality of life.
Pain-focused CBT teaches patients to identify “pain catastrophizing” — a thinking pattern where pain is interpreted as unbearable, unending, or threatening — which research has shown dramatically amplifies pain intensity. Through structured exercises, patients learn to challenge these thoughts and replace them with more accurate, balanced perspectives.
What You’ll Learn
- Identifying and challenging catastrophic pain thoughts
- Pacing activities to avoid the boom-bust cycle
- Behavioral activation to stay engaged with life
- Sleep hygiene and relaxation strategies
- Problem-solving for pain-related challenges
What the Research Shows
- 20–30% reduction in pain intensity on average
- Significant improvements in physical function and disability
- Reduced depression, anxiety, and pain catastrophizing
- Effects are maintained long-term after treatment ends
- Enhances the effectiveness of medical procedures
› Mindfulness-Based Stress Reduction (MBSR) Training attention to reduce pain’s emotional grip and suffering
Mindfulness-Based Stress Reduction (MBSR) was developed by Dr. Jon Kabat-Zinn at the University of Massachusetts Medical Center specifically for patients with chronic pain and stress-related conditions. It teaches patients to observe pain sensations, thoughts, and emotions with non-judgmental awareness — changing their relationship with pain rather than fighting it.
Chronic pain causes suffering not just from the sensation itself, but from the fear, frustration, anger, grief, and resistance it generates. MBSR addresses this “second arrow” of suffering directly. Research using neuroimaging shows that MBSR actually changes brain structure and function in regions involved in pain processing, attention, and emotional regulation.
Core Practices
- Body scan meditation for pain awareness
- Sitting and walking mindfulness meditation
- Mindful movement and gentle yoga
- Mindful eating and daily life awareness
- Stress reduction and breath-focused techniques
Benefits for Pain Patients
- Reduces pain unpleasantness (suffering) significantly
- Lowers stress hormones that amplify pain
- Improves sleep quality and fatigue
- Decreases anxiety and depressive symptoms
- Increases sense of control and self-efficacy
› Acceptance and Commitment Therapy (ACT) Building a meaningful life alongside — not despite — chronic pain
Acceptance and Commitment Therapy (ACT) takes a different approach to pain management: rather than primarily trying to eliminate or reduce pain, it focuses on helping patients build a rich, meaningful life even while pain is present. ACT recognizes that the more energy spent fighting pain, avoiding activities because of it, and trying to suppress pain-related thoughts and emotions, the more limited and painful life becomes.
ACT teaches “psychological flexibility” — the ability to be present with difficult experiences without being controlled by them, while moving toward what matters most in life. Research shows ACT is particularly effective for patients with longstanding chronic pain who have experienced significant life restriction, and it addresses pain catastrophizing, avoidance, and loss of identity that accompany many chronic pain conditions.
Core ACT Processes
- Acceptance — opening up to pain without fighting it
- Defusion — unhooking from unhelpful pain thoughts
- Values clarification — what matters most to you?
- Committed action — moving toward your values
- Present-moment awareness — mindfulness in daily life
Outcomes in Research
- Significant reductions in pain interference with daily life
- Improved physical, social, and occupational function
- Reduced depression, anxiety, and distress
- Greater life engagement and sense of meaning
- Effects maintained at 3- and 12-month follow-up
› Dialectical Behavior Therapy (DBT) Emotional regulation and distress tolerance skills for pain management
Dialectical Behavior Therapy (DBT) was originally developed for emotional dysregulation but has been adapted effectively for chronic pain management, particularly for patients whose pain is significantly amplified by emotional distress, interpersonal difficulties, or co-occurring mood disorders. DBT skills are practical, concrete tools that patients can use in the moment when pain flares or distress peaks.
Our psychologist Dr. Burkett completed specialized training in DBT and integrates relevant DBT modules into pain treatment — particularly the distress tolerance and emotion regulation components, which help patients ride through pain flares without making them worse through avoidance, catastrophizing, or impulsive responses.
Key DBT Skills for Pain
- Distress tolerance — surviving pain flares without worsening
- Emotion regulation — reducing emotional amplification of pain
- Interpersonal effectiveness — communication with family and providers
- Mindfulness — present-moment awareness without judgment
Who Benefits Most
- Patients with high emotional sensitivity to pain
- Those with co-occurring depression or anxiety
- Patients with significant pain-related relationship difficulties
- Those who find standard CBT insufficient alone
Who Can Benefit from Pain Psychology?
Pain psychology is appropriate for any patient living with chronic pain — regardless of the diagnosis, duration, or prior treatments. It is particularly valuable in these situations:
When pain has led to activity avoidance, social withdrawal, reduced function, or inability to work, psychological intervention addresses the behavioral and emotional patterns driving that limitation — not just the pain itself.
Depression and anxiety both lower pain threshold and increase the brain’s sensitivity to pain signals. Treating them directly produces measurable pain relief in addition to improving mood.
Pain and poor sleep form a vicious cycle — each makes the other worse. Cognitive behavioral therapy for insomnia (CBT-I) is one of the most effective treatments available and is often incorporated into pain psychology treatment.
Psychological preparation before procedures reduces anxiety, improves outcomes, and enhances recovery. Post-procedure psychology support maximizes functional gains from injections, ablations, and spinal cord stimulation.
When the nervous system itself has become the primary pain amplifier, psychological treatment targeting central sensitization and catastrophizing is often the most effective intervention available.
If injections, medications, or procedures have provided only partial relief, the addition of psychological care frequently unlocks substantially greater improvement — because the psychological component of pain was not yet being addressed.
What to Expect at Your Appointment
Pain psychology at Sweetwater Pain & Spine is integrated, evidence-based, and patient-centered. Here is what your experience will look like:
Your first appointment is a thorough assessment of how pain is affecting your life — physically, emotionally, socially, and occupationally. Dr. Burkett reviews your pain history, prior treatments, sleep, mood, activity levels, relationships, and goals. No judgment, no rush. This is the foundation for a personalized treatment plan.
Based on your evaluation, Dr. Burkett recommends the most appropriate evidence-based approaches for your specific situation — CBT, ACT, MBSR, DBT skills, or a combination. Goals are collaborative: you and your psychologist define what success looks like for you, anchored in your values and the life you want to live.
Sessions are typically 50 minutes, conducted on a schedule that fits your needs. You will learn specific skills, practice them between sessions, and build on them progressively. Pain psychology is active and skill-based — not just talking about pain, but building practical tools to change your relationship with it.
Dr. Burkett and your Sweetwater pain physician communicate regularly to ensure your psychological care and medical care are working in concert. This integrated model — unlike siloed referrals — produces significantly better outcomes than either type of care alone.
As you gain skills and improve, sessions taper to support your independence. Before completing treatment, you will have a personalized relapse prevention plan — a toolkit of strategies for managing pain flares, difficult days, and life stressors so your gains are durable.
Sarah Burkett, PhD
Pain Psychologist
Dr. Sarah Burkett earned her PhD in Clinical Psychology from the California School of Professional Psychology at Alliant University in Sacramento. She completed her pre-doctoral internship at Ventura County Behavioral Health, where she received specialized training in outpatient substance abuse, Dialectical Behavioral Therapy, and behavioral medicine.
Dr. Burkett completed her post-doctoral training at Northern Nevada Adult Mental Health Services with an emphasis on outpatient therapy including Mindfulness-Based Stress Reduction for Chronic Pain groups, Co-Occurring Disorders, and Anger Management. Licensed since 2015, she subsequently worked at Renown and Rural Mental Health providing outpatient therapy with an emphasis in health psychology, psychological assessment, and cognitive-behavioral treatment for anxiety disorders and chronic disease management.
Dr. Burkett is a qualified supervisor for Psychological Assistants and brings a warm, evidence-based approach to each patient — meeting them where they are and collaborating toward the life they want to live.
Our Four Northern Nevada Locations
645 N Arlington Ave
Suite 670
Reno, NV 89503
10451 Double R Blvd
Reno, NV 89521
4838 Sparks Blvd
Suite 102
Sparks, NV 89436
412 W John St
Suite B
Carson City, NV 89703
Chronic pain affects the whole person. Our team — physicians and psychologist working together — is here to help you find lasting relief and reclaim your life.