Med/Psych Update

Chronic pain and psychiatric illness: Managing comorbid conditions

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Integration of these interventions within a biopsychosocial framework can assist you in making a comprehensive treatment plan. For example, patients with focal myofascial shoulder and back pain might derive only transient benefit from trigger point injection. However, concurrent referral to a pain psychologist and physical therapist could substantially improve functional outcomes by addressing factors that directly and indirectly influence myofascial pain. Inclusion of cognitive-behavioral therapy (addressing psychosocial and lifestyle dimensions), surface electromyography, psychophysiological interventions/biofeedback (addressing psychosocial, lifestyle, and physiological dimensions), and physical therapy (addressing lifestyle and physiological dimensions) allows the patient to learn coping skills, decrease physiological arousal that can lead to unnecessary tensing of muscles, and strengthen core muscle groups.

Bottom Line
Treating chronic pain in patients with concomitant psychiatric illness can be challenging. A multimodal approach that includes appropriate medications, interventional procedures, physical therapy, and behavioral therapies improves pain, psychiatric illness, and functioning and enhances a patient’s sense of well-being.

Related Resources
  • Ananth K, Richeimer S, Durham MJ. Managing chronic pain: consider psychotropics and other non-opioids. Current Psychiatry. 2012;11(2):38-42,A.
  • Chou R, Fanciullo GJ, Fine PG, et al; American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113-130.

Drug Brand Names
Amitriptyline • Elavil
Botulinum toxin A • Botox
Celecoxib • Celebrex
Desipramine • Norpramin
Desvenlafaxine • Pristiq
Duloxetine • Cymbalta
Gabapentin • Neurontin
Indomethacin • Indocin
Ketorolac • Toradol
Milnacipran • Savella
Nortriptyline • Pamelor
Pregabalin • Lyrica
Venlafaxine • Effexor

The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of completing products.


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