Chronic pain is a public health problem of pandemic proportions that affects more than 70 million Americans. It’s among the most common concerns for healthcare professionals, and the annual costs associated with chronic pain have been estimated at approximately $100 billion due to medical expenses, as well as loss of earnings and productivity. Studies estimate that about 50% of community-dwelling elderly people and as many as 80% of nursing home residents experience chronic pain.
One of the most daunting challenges for psychiatric professionals is to distinguish physical and emotional symptoms that patients experience in the context of pain. Despite the fact that the physical and psychological aspects of pain are closely linked, surprisingly few pain-related themes are included in psychiatric residency training. According to current demographic trends, there appears to be a shortage of pain experts, further complicating care for patients. There will be a greater need for training in pain management, especially as the overall proportion of geriatric patients continues to increase. Older individuals, in particular, are at higher risk for developing pain-related conditions.
Analyzing Current Trends of Pain Management Education
In a review article published in the January 2011 Archives of Internal Medicine, my colleagues and I assessed why it’s important to teach pain management to psychiatrists. A central theme of our article was that pain education should be an integral part of the core curriculum of psychiatric residency programs. A wide range of psychiatric conditions are associated with heightened pain prevalence, including major depressive disorder, borderline personality disorder, addictions, and PTSD. Since pain is exceedingly prevalent in psychiatric patients, psychiatrists will be faced with increasing numbers of patients with pain.
“Surprisingly few pain-related themes are included in psychiatric residency training.”
Most pain syndromes are only partially responsive to opioids and pain therapies. As such, innovative approaches to pain management are essential. Psychiatrists are suited to recognize and treat subtle psychological processes, including the expression of feelings by way of somatic pain concerns, psychological defense mechanisms, and conscious and unconscious motivations. Psychiatrists could also help to enhance patient compliance and participation in pain treatment plans.
A New Role for Psychiatrists in Pain Management?
Adding pain management to psychiatric training may redefine the role of psychiatrists in the management of this difficult-to-treat patient group. Accepting this new role in patient care, teaching, and research may be a substantial clinical contribution in a domain that currently offers little in terms of effective therapeutic interventions. Numerous cognitive and behavioral strategies have been shown to be helpful for chronic pain, and psychiatrists can become strong advocates for using these techniques in the field of pain. Since psychiatrists are experts in psychopharmacology, they can promote the safe use of opioid drugs and non-addictive analgesic alternatives. Psychiatrists can also diagnose and treat suicidal tendencies, as well as mood, anxiety, psychotic, and personality disorders, all of which are factors that can have strong effects on treatment outcomes.
It’s a public health interest to engage psychiatrists in the care of patients with chronic pain. Doing so will generate additional clinical expertise to evaluate and treat a large spectrum of pain-related problems. It’s important to expand the field of psychiatry to include pain as an entity rooted in other specialties, such as neurology, medicine, surgery, and anesthesiology. Pain training would also advance the integration of psychiatry into mainstream medical care and underscore the significance of both mental and physical problems.
Elman I, Zubieta JK, Borstook D. The missing P in psychiatric training: why it is important to teach pain to psychiatrists. Arch Gen Psychiatry. 2011;68:12-20. Available at: http://archpsyc.ama-assn.org/cgi/content/full/68/1/12#AUTHINFO.
Sharp J, Keefe B. Psychiatry in chronic pain: a review and update. Curr Psychiatry Rep. 2005;7:213-219.
Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being: a World Health Organization study in primary care. JAMA. 1998;280:147-151.
Leo RJ, Pristach CA, Streltzer J. Incorporating pain management training into the psychiatry residency curriculum. Acad Psychiatry. 2003;27:1-11.