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Should Psychiatrists Manage Pain?

Charles E. Argoff, MD

Hi. My name is Dr. Charles Argoff, Professor of Neurology at Albany Medical College and Director of the Comprehensive Pain Center at Albany Medical Center in Albany, New York. I’d like to talk today about the role of behavioral care, specifically the role of a psychiatrist, in managing chronic pain. I’ve been doing pain management (I don’t want to date myself) for over 20 years. It was an interest of mine when I was doing my neurology residency and thereafter, I focused my professional activities on this area.

Charles E. Argoff, MD

Posted: 02/24/2011

Hi. My name is Dr. Charles Argoff, Professor of Neurology at Albany Medical College and Director of the Comprehensive Pain Center at Albany Medical Center in Albany, New York. I’d like to talk today about the role of behavioral care, specifically the role of a psychiatrist, in managing chronic pain. I’ve been doing pain management (I don’t want to date myself) for over 20 years. It was an interest of mine when I was doing my neurology residency and thereafter, I focused my professional activities on this area.

However, what has amazed me is how almost every person I’ve seen with chronic pain including chronic headache problems, really could have benefitted from the intervention of a behavioral person, specifically a psychiatrist, and how often today it is virtually impossible to get someone with a psychiatric background to actually participate in the care of somebody who has chronic pain.

One can think of several issues considering the role of psychiatry in behavioral medicine for management of chronic pain. First, why is it important? Mental health disorders are very common. Whereas they may not cause someone’s chronic pain disorder, they’re often associated with chronic pain disorders. We’ve all been brought up to understand and believe in our hearts that managing each component of a person’s problem as effectively as possible is vital, so psychiatrists and behavioral health specialists are extremely important in the overall management of someone who has chronic pain.

Second, it’s more than just managing (or seeing) the patient one time. Depression and anxiety are very common conditions and they need active management by a person with a psychiatric or behavioral health background. Unfortunately, not many people who require these services have access to these services.

What should a psychiatrist or behavioral health professional know about chronic pain? More professionals in these fields may benefit from pain-related educational activities. They may benefit from actually seeing patients in a pain center, so that they can learn more about the breadth of the range of presentations of different pain problems. In certain settings, professionals only get to see those individuals who are having the most difficulties (perhaps those who are drug-dependent either physically or psychologically or both) but it’s very important for professionals in psychiatry to learn the principles of pain management. Behavioral medicine is such an important part of the treatment of chronic pain and chronic headache disorders that if more psychiatrists had pain training, it would add substantially to our ability to take care of people with chronic pain and headaches. Thank you very much.

Professor, Department of Neurology, Albany Medical College; Director, Comprehensive Pain Program, Albany Medical Center, Albany, New York

Disclosure: Charles E. Argoff, MD, has disclosed the following relevant financial relationships:
Received grants for clinical research from: Eli Lilly and Company; Endo Pharmaceuticals; Forest Laboratories, Inc.; Pfizer Inc.
Served as a consultant for: Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol-Myers Squibb Company; Eli Lilly and Company; Endo Pharmaceuticals; Forest Laboratories, Inc.; Grüenthal Group; King Pharmaceuticals Inc.; Pfizer Inc.; sanofi-aventis; Solvay Pharmaceuticals, Inc.
Served as a speaker or member of a speakers bureau for: Eli Lilly and Company; Endo Pharmaceuticals; Forest Laboratories, Inc.; King Pharmaceuticals Inc.; Pfizer Inc.; PriCara

Medscape Neurology & Neurosurgery © 2011 WebMD, LLC

 

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