People with pain often have trouble getting answers, and find that medical providers either do not want to deal with them, or quickly offer to put them on potent opioid pain medicine for the rest of their lives. What if these people heard, “we know where the problem is and how to help you – and it’s not going to require painkillers”? What if “difficult pain patients” became easy for their provider to diagnose and treat?
Drs Davis and Vanderah have just published a landmark paper in one of the leading primary care journals, The Journal of Family Practice, that takes a giant stride in this direction. This article opens up a new dimension in the understanding of pain, and specifically targets our primary care providers because they are on the front lines of pain treatment. The authors review well established concepts about nociceptive and neuropathic pain, and then introduce “pain for psychological reasons.” The authors show how a primary care provider might learn to recognize which type of pain their patient has and describe how this could change treatment planning. The article opens new avenues for ending America’s opioid crisis by addressing the opioid problem at its roots – pain for psychological reasons. It also provides a new foundation for improving the quality of pain care and reducing cost of unnecessary treatment. This article is meant to help prioritize research, teaching, and health policy priorities as well.
“I hurt” can mean many things. All experienced healthcare providers have had the experience of treating patients who talk about pain but do not have any tissue pathology. There is no question that the pain is very real and the patient is not misleading their physician in any way. Many of these patients have pain for psychological reasons described in the article. Armed with an understanding of this we can start to avoid mistakes such as escalating opioid doses for a patient with pain for psychological reasons without tissue damage, people who may have a severe developmental trauma history that puts them at risk for overusing medications.
For those involved in the effort to establish value-driven care through health system quality improvement, this article will be of assistance in developing new system performance metrics. In a medical clinic where best practices of understanding pain are guiding evaluation and treatment, one would find several concepts from this article in place. For example, one would find the screening tools described in this article being used, one would find diagnoses such as ICD-10 code F54 “Psychological factors affecting chronic pain” being used, and referral for behavioral health services would be linked to diagnosis F54. This article also has implications for health care managers, health insurance plans, and policy makers. Healthcare reimbursement schemes must facilitate more complete integration and coordination of behavioral with medical evaluation and treatment – especially at the primary care level.
For those who make decisions regarding research funding, we desperately need funding to develop human models of pain without tissue damage that will facilitate the basic science research needed define better what this is, what to do about it, and how to prevent it. Clinical questions such as “do opioids ‘work’ for this type of pain?” and “is this a population at risk for opioid-related adverse events?” cannot be definitively answered in the absence of basic science and epidemiologic research.
For healthcare policy professionals and patient advocacy groups, this article provides direction – it underscores the need to fully integrate behavioral medicine into traditional medical practice at all levels, especially in primary care and pain medicine clinics.
Read the full article now: What is Pain? The New Paradigm