Pain has a very complex mechanism. Some of the causation of pain is blamed on stress, anxiety and depression, situations where the pain threshold is much lower. It is often difficult to fully disprove an organic pathology in pain. Thus there is a need for pain specialists, including rheumatologists, to work closely with psychiatrists and vice versa.
Culture dictates that psychiatrists often would request that physicians manage and disprove an organic pathology before a referral. The reality is that disproving an organic pathology can sometimes be difficult. Another valid point to stress is that pain has a multifactorial aetiology in most instances.
This linked article above highlights the fact that many mechanisms of action of medications are not fully understood. When pain management becomes complex and the list of medications grow, it may sometimes be prudent to stop some of them. Anecdotally, many patients improve when the list of medications is truncated. This lends credence to medications as a possible cause of pain in many instances.
Specialists must learn to work together and communicate better. This can sometimes help patients and avoid wastage and unnecessary procedures or tests. It will need the minds of many specialties to help alleviate and not complicate the management of pain in our patients.