Psychiatric screening and initial management in interventional pain practice: a narrative review and the Daradia Protocol

Psychiatric comorbidities are common in chronic pain and can meaningfully influence safety, satisfaction, adherence, and durability of benefit after interventional pain procedures. Interventional pain physicians, typically trained in anesthesiology, often have limited time and limited access to liaison psychiatry, creating a gap between guideline intent and real-world feasibility. This narrative review summarizes clinically relevant psychiatric domains for interventional pain practice, highlights situations where procedures should proceed, be optimized in parallel, or be deferred, and outlines a pragmatic approach to screening and first-line management in busy clinics. The authors describe brief screening tools, including validated instruments where applicable, that can be implemented within routine workflow to identify depression, anxiety, suicidality, substance misuse risk, and maladaptive coping, and they propose the Daradia Protocol, a structured 10-minute stepped-care pathway that stratifies patients into Green, Amber, and Red risk categories to guide procedural decision-making and referral urgency. Clinic-initiated strategies emphasize psychoeducation, expectation alignment, graded activity, sleep support, and coordinated care with mental health professionals when indicated. Embedding rapid screening with clear action thresholds may strengthen informed consent, improve patient selection, and increase the likelihood of durable outcomes without materially extending consultation time.