Abstract
Psychological interventions represent a core component of contemporary interdisciplinary chronic pain treatment, yet treatment initiation following referral to pain psychology services remains consistently low. Empirical studies across behavioral health and pain medicine demonstrate that referral alone is insufficient to ensure patient engagement with psychological care. This gap between referral and treatment initiation represents a major implementation barrier limiting the impact of evidence-based psychological pain interventions. The present article synthesizes contemporary literature on behavioral health treatment initiation and chronic pain psychology to propose a structured engagement framework designed to improve initiation rates following referral. Using a targeted narrative review methodology, empirical literature published between 2021 and 2025 was examined to identify key determinants of treatment initiation across pain medicine and integrated behavioral health settings. Findings indicate that treatment initiation is best conceptualized as a multistep process involving referral communication, structural and attitudinal barriers, patient readiness, psychoeducation, and system-level facilitation. Evidence from collaborative care models suggests that active engagement strategies embedded within medical workflows can substantially improve treatment initiation rates compared with passive referral approaches. The proposed Active Engagement Model of Pain Psychology Referral integrates individual-level and system-level interventions designed to address common barriers to treatment initiation. Improving initiation requires a shift from passive referral models toward proactive engagement strategies embedded within interdisciplinary pain care. Implementing structured engagement approaches may substantially improve access to evidence-based psychological interventions for chronic pain.
Keywords
Treatment, Initiation rates, Pain psychology, Chronic pain, Behavioral health