I spent a day with a pain psychologist. In most cases, the management of chronic pain requires attention to the psychological aspects of the illness. This is not to say that people with chronic pain have psychiatric disease, but rather that there are psychological tools that patients in pain should use to manage their symptoms. This is not surprising. The patients we see are so debilitated that they cannot sleep, have a poor diet, hurt when they exercise, cannot hold a job, and feel like no relief is in sight. This prospect is scary, anxiety-provoking, and depressing. Sometimes they feel that their physicians aren't taking them seriously or have tried everything with little success. Sometimes, they just want someone to listen.
And that's what we do. Working with a psychologist reminds me that the non-medical history, the social history, can be incredibly rich. We draw out the childhood history, think about interactions with parents or siblings, look at a patient's educational history. Some have had traumatic childhoods, gone through the correctional system or foster homes, and this makes a big difference in their coping mechanisms and outlook. We examine a patient's employment history, see how job and financial stressors play a role in their life. We ask about marriages and divorces, children and pets. We go beyond the usual "alcohol, smoking, drugs" and look at caffeine use, attempts at detox, attitudes about opiates. We take a detailed psychiatric history. All of this gives us the background picture, the milieu, that stews and exacerbates the patient's chronic pain. It is the stuff that gets in the way of effective treatment. It helps us anticipate the obstacles a patient must overcome.
In this rotation, I have become more and more convinced that the mind and the body are incredibly co-dependent. Medications alone cannot cure chronic pain. So we try to identify and give patients the tools and coping strategies to deal with what is likely a life-long condition. Though it is easy to dismiss this stuff as "fuzzy" and "imprecise," it is the art that complements the science of treatment.
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5 comments:
I have a chronic pain disorder and would love to be able to see a therapist, but the way my insurance decides what they will and won't cover (for mental health) is so hard to track I've kind of given up. They will cover my Cymbalta, which means I only have to pay $60/month for it. Oh, and the Ambien that I need to sleep due to both pain and anxiety. Lovely system we have, isn't it? :)
I'm sorry to hear that. Especially now that I'm in an outpatient clinic, I've talked to so many patients who have struggled with navigating through the system. It's pretty dysfunctional, completely unintelligible even to providers, and very frustrating.
Yes. It's also just silly to me that drugs (which are helpful to be sure) are covered, while things (like therapy) that would address the root problem are not. I'd much rather be working with a therapist on my sleep habits than taking Ambien every night. One of the best things I've ever done for myself was to hire a nutrition counselor after I was diagnosed with fibromyalgia. It completely changed my life and helped me manage the illness more than anything else has, but I had to pay for it all out of pocket. It was completely worth it, but I wish these more holistic methods were valued by insurance companies.
yes! I'll definitely write a few more posts about this, but our approach to pain is multidisciplinary and we heavily emphasize physical therapy and psychology. we don't yet do nutrition in our pain clinic (though the digestive clinic is next door and we should probably connect with them more) but it's a great idea. unfortunately, most of our patients have the same deal with insurance which covers meds and interventions but not the other holistic stuff, which is just as important
Ooh cool! That's so great that the patients get to work with everyone in such a complete way. It would be awesome if you could work with the digestive folks since, at least with fibro, the two are so strongly linked. When I started getting sick with what eventually became fibro, all the problems manifested as stomach and urinary tract problems, and I was diagnosed with IBS. It's cool learn about how they all link together. I think it would also be hugely valuable for your patients to get to work with a nutrition person...I think cutting back on sugar (and dairy and gluten too) is the most effective thing I've done for managing my pain. If ever I'm having a lot of pain, 9 times out of 10 it's because I've been eating too much sugar. Avoiding processed foods also helps a whole lot. And I think I'm going to go comment on your new post too :)
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