Treatment Approach to Chronic Pain. Richard H. Cox, MD, PhD, DMin Sharon A. Bell, PsyD. Sharon A. Bell, PsyD

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1 22nd Annual Fall Symposium Arizona Geriatrics Society NeuroNeuro-BioNeuro-BioBioPsychological Treatment Approach to Chronic Pain Richard H. Cox, MD, PhD, DMin Sharon A. Bell, PsyD Affiliations Richard H. Cox, MD, PhD, DMin, DAAPM Adj. Professor, Dep't. Psychiatry, Neurology, Behavioral Science Duke University Medical School, Durham, Scholar, Georgetown Univ. Medical School, Center for Clinical BioEthics, Washington, DC Sharon A. Bell, PsyD St. Joseph-SunHealth Geriatric Fellowship, Phoenix, AZ Financial Disclosure There are no conflict of interest or financial disclosures to be made.

2 Learning Objectives 1. Illustrate Differences Between Grief, Pain, and Suffering 2. Describe diagnostic and treatment techniques that fit specific cases 3. Identify specific markers for outcomes measurement Etiology Grief: Deep sorrow, nonpathological, result of loss; Pain: Physical and emotional dysfunction due to physical or psychological pathology; Suffering: Emotional, Spiritual, Philosophical. May become pathological. Grief vs. Suffering Grief: An external loss. Unconscious process. Related to mourning an actual loss of some THING; Suffering: Internal or external conscious process. Sorrow results from the emotional connection to what the THING (real or imagined) provided;

3 Examples of Grief Grief: Permanent loss Death - Divorce Career Loss - Terminal Illness Diagnosis Amputation - Vision or Hearing Loss Loss of Appearance - Relationship Loss Death of Pet - Acute or Chronic Violence Loss of Health - Loss of Independence Bankruptcy - Shattered Dreams Disability - Major Move Examples of Pain Pain: Disruption of normal functional physiological or emotional processes Amputation - Burns Spinal Cord Injury - Fibromyalgia Migraine Headaches - Stroke Parkinson s Disease - Arthritis Neuropathy - Back injury/disease Depression - Anxiety IBS/Crohn s Disease - Cancer Examples of Suffering Suffering: Suffering is secondary to a loss Husband dies (loss). Wife misses companionship (suffering) Low back injury/failed surgery (loss). Person frustrated by decline in function, work, entertainment, etc. (suffering) Amputation (loss). Person frustrated with re-learning to balance, walk, shower, limitations, etc. (suffering)

4 Process of Decline Cox, R (2010) Diagnostic Method Cox, R. & Bell, S. (2006) Diagnostic Approach/Treatment Planning LOOK - carefully observe the patient Lab findings, clinical findings Patient behavior Affect/overall presentation LISTEN - careful history taking What is the patient saying/not saying? What are patient/referral expectations? What does the patient think is wrong? LEARN - What is the primary underlying problem? Who is best to put on the healing team? What to do What NOT to do

5 Treatment Planning Grief: Psychological and spiritual (primary), family, friends, clergy; Pain: Medical (primary) with psychological intervention ancillary; Suffering: Psychological and spiritual (primary) with medical intervention ancillary. Outcomes Measures Lower average pain scores Decreased use of medications Increased function: ADLs, social activities, mobility, participation in treatment Improved physiology: Laboratory data, mental status, vital signs, etc. Improved Mood Improved Relationships Patient Scenario One A 74-year-old male who suffered with chronic pain conditions for 30+ years, suffered Right CVA and now in rehabilitation with behavioral issues.

6 Patient Scenario Two A 71-year-old female who suffered w/post-polio syndrome since childhood. Admitted to LTC s/p leg fracture. Patient Scenario Three An 86-year-old male who was found unconscious in his home by a neighbor. During his hospitalization he fell and sustained a hip fracture. His pain level is 10/10 and he expresses a wish for death. Suggested Reading Anderson, U., Immunology of the Soul, Health Access Press, Sanford, FL, chap.3 Beauregard, M., O Leary, D., The Spiritual Brain, Harper Perennial, Canada chaps. 8,9. Benson, H. Timeless Healing, Scribner, NY chaps. 4, 8, 11. Boswell, M., Cole, B., Weiner s Pain Management, 7 th Edit., CRC Press, Boca Raton, FL. 2006

7 Suggested Reading Cox, R., Cox, B., Hoffman, L., Spirituality and Psychological Health. Colorado School of Professional Psychology, Colorado Springs, CO Dossey, L., Healing Words, Harper, NY Frank, R., Rosenthal, M., Caplan, B., Handbook of Rehabilitation Psychology, American Psychological Association, Washington, DC 2010 Lipton, B., The Biology of Belief, Elite Books, Santa Rosa, CA chaps. 2,3,5. Newberg, A., Why We Believe What We Believe, Free Press, NY chaps 2,4,10. Suggested Reading Nuland, S.B., The Wisdom of the Body, Knopf, NY chap 6 Taylor, R.L., Mind and Body, McGraw-Hill, NY chap 8. Tiller, W.A., Science and Human Transformation, Pavior, Walnut Creek, CA Rieber, R., Carton, A.S., The Collected works of L.S. Vysotsky, Plenum, NY. 1987,, chaps.1,6. Westberg, G., Good Grief, Out of print, available via Amazon

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