Background: Consultation psychiatrists are often thrust into a variety complex medical situations demanding expertise in multiple areas, yet chronic pain management has not often been prioritized in psychosomatic medicine (PM) training, and instead has been dominated by clinical input from anesthesiologists and neurologists. However, many chronic pain syndromes are defined by extensive psychiatric comorbidities, including but not limited to depression, anxiety, insomnia, addiction, stress, and other pathologies. Given the current emphasis of non-opioid pain management strategies and the theme of APM 2017 (“Consultants Consulting the Experts”), it is important to review the ways consultation psychiatrists may skillfully contribute to chronic pain management.
Methods: Via several case-based, interactive educational sessions timed at approximately 15-20 minutes each, three PM-trained consultation psychiatrists who manage chronic pain syndromes in their daily practice will present their chronic pain diagnostic, evaluation, and treatment strategies. Specifically, these discussions will offer tangible deliverables for the audience in terms of assessment (criteria, screeners/scales, important features suggesting non-acuity, physical examination, history), psychoeducation (how to describe pathophysiology to patients and families), treatment approaches (psychopharmacological, role of detoxification, biofeedback, psychotherapeutic), and consultation to other clinicians (role of evaluation, collaboration, and consultee education/service).
Each speaker will focus on a particular area of chronic pain management:
Xavier Jimenez, MD (Medical Director, Chronic Pain Rehabilitation Program, Cleveland Clinic): Central sensitization syndromes (fibromyalgia, others)
Harold Goforth, MD (Staff, Headache Section, Center for Neurological Restoration, Cleveland Clinic): Migraine/headache management
Robert McCarron, DO (Director, Pain Psychiatry, UC Davis): Back pain management
Results: It is anticipated that this session will result in enhanced awareness of the many contributions the consultation psychiatrist is able to offer in common chronic pain management scenarios. It is also anticipated that this session will provide confidence to consultation psychiatrists with tangible deliverables. Finally, it is anticipated that this session will encourage lively discussion regarding the role of the consultation psychiatrist and potential challenges/opportunities faced in broadening his/her clinical scope to include chronic pain management.
Conclusion: Consultation psychiatrists have much to offer in the important and growing clinical realm of chronic pain management. Some simple yet effective strategies in managing chronic central sensitization, migraine/headache, and back pain syndromes are worthy of exploration and dissemination.