Psychiatry - December 2008 - (Page 20)

[PSYCHOTHERAPY ROUNDS] SERIES EDITOR: PAULETTE M. GILLIG, MD, PhD Professor of Psychiatry, Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio. Why Psychotherapy Helps the Patient in Chronic Pain by LINDA J. GRIFFITH, MD Board Certified, American Board of Psychiatry and Neurology, American Board of Family Medicine, American Board of Hospice and Palliative Medicine, Certificate of Added Qualifications in Geriatrics; Chief Medical Officer, Consolidated Care, Inc., Champaign and Logan Counties, Ohio; and Clinical Assistant Professor, Boonshoft School of Medicine, Wright State University, Dayton, Ohio Psychiatry (Edgemont) 2008;5(12):20–27 ABSTRACT Psychiatrists frequently see patients in their practices who struggle with issues of chronic physical pain. This can present diagnostic and therapeutic dilemmas. These patients require an approach that allows them to talk about their pain and feel supported while simultaneously being nudged to develop a meaningful life alongside their pain. This article addresses an approach to accomplish this difficult balancing act over the course of time and includes case examples. INTRODUCTION Individuals with chronic pain are common in psychiatric practice. It has been reported that 38 percent of psychiatric inpatients and 18 percent of psychiatric outpatients report pain as a significant concern.1 Physicians, including psychiatrists, have numerous reactions to such individuals, often negative, if not openly pejorative and hostile. Faced with a patient complaining of pain that has not responded to the usual interventions, or for which no clear etiology has been determined, we often internally sigh and bow our heads in weariness. If the individual remains in our practice and continues to complain, this feeling can border on despair. How can I possibly help this person? Why don’t they listen to my sage advice? Why won’t they focus on something other 20 Psychiatry 2008 [ V O L U M E 5, NUMBER EDITOR’S NOTE: All cases presented in the series “Psychotherapy Rounds” are composites constructed to illustrate teaching and learning points and are not meant to represent actual persons in treatment. ADDRESS CORRESPONDENCE TO: Linda J. Griffith, MD, Consolidated Care, 118 Maple Ave. W, Box 670, Bellefontaine, OH 43311; Phone (937) 599-1975; Fax: (937) 599-2769; E-mail: lgriffith@ccibhp.com KEY WORDS: pain, chronic pain, addiction, pseudoaddiction, dependence, tolerance, psychotherapy, aberrant drug-related behaviors, aberrant drug-taking behaviors 12, DECEMBER]

Table of Contents Feed for the Digital Edition of Psychiatry - December 2008

Psychiatry - December 2008 Editor’s Message Contents Editorial Advisory Board Antidepressant Prescribing by Specialty and Treatment of Premenstrual Dysmorphic Disorder Pain, Pain, Go Away: Antidepressants and Pain Management Why Psychotherapy Helps the Patient in Chronic Pain General Medical Drugs Associated with Depression Katatonia: A New Conceptual Understanding of Catatonia and a New Rating Scale Thermoregulation and the Role of Calcium Signalling in Neurotransmission Cognition and Schizophrenia: Is There a Role for Cognitive Assessments in Diagnosis and Treatment? Journal Watch Information for Authors

Psychiatry - December 2008

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