R. Scott Stayner, MD, PhD Pain Specialist St. Vincent Physician Network Pain Center Billings, Montana
Amir Ramezani, PhD Pain Psychology and Neuropsychology Pain Psychiatry and Behavioral Medicine Services Department of Anesthesiology and Pain MedicineUniversity of California, Davis School of Medicine Sacramento, California
Ravi Prasad, PhD Clinical Associate Professor Division of Pain Medicine Stanford University Palo Alto, California
Gagan Mahajan, MD Professor Medical Director Division of Pain Medicine Department of Anesthesiology and Pain Medicine University of California, Davis School of Medicine Sacramento, California
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.
Disclosures The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of completing products.
