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Do Psychiatrists Need Pain Training?

Do Psychiatrists Need Pain Training?

Pain education should be an integral part of the core curriculum of psychiatric residency programs, according to an article published in the January issue of Archives of General Psychiatry.

In a Perspectives article, experts from Harvard Medical School, Boston, Massachusetts, and the University of Michigan, Ann Arbor, note that despite the fact that the physical and psychological aspects of pain are closely linked, “remarkably few pain-related themes are included in psychiatric residency training.

Do Psychiatrists Need Pain Training?

January 19, 2011 — Pain education should be an integral part of the core curriculum of psychiatric residency programs, according to an article published in the January issue of Archives of General Psychiatry.

In a Perspectives article, experts from Harvard Medical School, Boston, Massachusetts, and the University of Michigan, Ann Arbor, note that despite the fact that the physical and psychological aspects of pain are closely linked, “remarkably few pain-related themes are included in psychiatric residency training.

“One of the most daunting challenges faced by psychiatric professionals is how to distinguish and approach physical and emotional symptoms arising in the context of pain experienced by their patients,” the study authors, led by Igor Elman, MD, write.

According to the article, chronic pain is the most common concern brought to healthcare professionals. It is estimated that 70 million Americans are affected with an associated annual total of $100 billion in medical costs and loss of earnings and productivity.

In addition, the study authors point out that the country’s aging population and a shortage of pain specialists further highlight the need for increased pain education. “Specifically, they note 50% of community-dwelling elderly people and as many as 80% of nursing home residents experience chronic pain.”

They add that a wide range of psychiatric conditions are associated with heightened pain prevalence, including major depressive disorder, borderline personality disorder, addictions and posttraumatic stress disorder.

Further, because pain is “exceedingly prevalent in psychiatric patients,” as more people age and experience pain, psychiatrists will be faced with growing numbers of pain patients.

The study authors also note that “most pain syndromes are only partially responsive to opioids and so innovative approaches are essential.

“Psychiatrists are understandably suited to recognize and treat subtle psychological processes, including expression of feelings via somatic pain concerns, defense mechanisms (denial and repression vs lying and malingering), and conscious and unconscious motivations, such as self-reported pain with adequate analgesia owing to unwarranted anxiety about an impending opioid dose reduction (ie, pseudo-opioid resistance) or drug craving vs pseudoaddiction or therapeutic dependence,” the study authors write.

They add that psychiatrists could help enhance patient compliance and participation in pain treatment plans.

Adding pain to psychiatric training and by extension “elevating psychiatrists’ new role in patient care, teaching, and research in the field of pain medicine may be a substantial clinical contribution in a domain that currently offers relatively little in terms of effective therapeutic interventions,” the study authors write.

Dr Jon-Kar Zubieta reports he is a consultant for Merck and Eli Lilly.

Caroline Cassels

Caroline Cassels is the news editor for Medscape Psychiatry. A medical and health journalist for 20 years, Caroline has written extensively for both physician and consumer audiences. She helped launch and was the editor of Health Digest, an award-winning Canadian consumer health publication. She was also national editor of the Heart & Stroke Foundation of Canada’s Web site before joining Medscape Neurology & Neurosurgery in 2005. She is the recipient of the 2008 American Academy of Neurology Journalism Fellowship Award. She can be contacted at [email protected]

Arch Gen Psychiatry. 2011;68:12-20.

 

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