2013 ASA Psychiatric Co-Morbidities lecture handout2013亚撒精神疾病讲义.docxVIP

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2013 ASA Psychiatric Co-Morbidities lecture handout2013亚撒精神疾病讲义.docx

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2013 ASA Psychiatric Co-Morbidities lecture handout2013亚撒精神疾病讲义.docx

Psychiatric Co-Morbidities in the Chronic Pain PatientRafael Miguel, M.D.Clinical ProfessorMedical DirectorPain Medicine ProgramPain Medicine ProgramDepartment of NeurologySarasota Memorial Healthcare SystemsUniversity of South FloridaSarasota, FloridaTampa, FloridaIntroductionIn 2000, Passik and Wenreb proposed the four A’s of treatment outcomes:Analgesia, Adverse Events, Activities of Daily Life (ADLs) and Aberrant Drug Taking.1The first concept necessary when faced with a pain patient is to recognize their realities. For this to happen a comprehensive evaluation needs to be performed, not just relating to the physical complaint but also to the frequently accompanying psychological pathologies.Substance abuse and psychopathology are frequently present in pain patients and often complicate pain treatment. While pain physicians are experts in treating pain patients, they are not necessarily experts in treating addicts and patients with psychiatric disorders. Pain physicians should be cognizant that these comorbid conditions are common in pain patients and be able to determine their existence and when they are affecting pain treatment negatively. These latter points should lead the prudent pain physician to seek and obtain prompt and appropriate specialty consultation.Psychological Assessment of the Chronic Pain Patient: The psychological evaluation is critical in assessing mood, coping skill, family support structure, expectations regarding pain management and impact on quality and activities of daily life. Pain physicians should be able to identify psychiatric symptoms and either establish an initial plan of treatment or make an appropriate referral.2 Pain creates a self-enforcing cycle that left untreated creates worsening lifestyle and a greater focus on pain disability. In back pain, successful treatment can be complicated by a variety of factors. These include beliefs that the back pain is harmful or disabling, fear avoidance behavior, kinesophobia, dep