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Resident PGY 4
Henry Ford Hospital
Background: As pain became avoidable with pills and other interventions, it became intolerable. Consequently, over 100 million people struggle with chronic pain; making up 20% of medical visits and 10% of drug sales. Discomfort from injury does not shut off even after the incident passes; there are structural differences as well as biochemical changes at the thalamus and medial prefrontal cortex. Research shows 27% of patients with pain meet criteria for depression, 35% for anxiety and 61% for substance use disorder. Chronic pain is a challenge for clinicians as well as the individuals who suffer from it. Patients are dependent on their providers for pain relief; when expectations aren’t met, anger and depression follow leading to doctor shopping, multiple costly, invasive, often unnecessary tests, over-reporting, debilitating behaviors and emotional distress. Managing this complex medical condition can contribute to physician burnout; research on burnout in pain medicine providers is limited. The purpose of this study was to determine if treating this demoralized population of patients is contributing to burnout and if fostering confidence in managing the psychological profiles of patients and decreasing their perceived burden of difficult encounters would protect against burnout. Methods: A cross-sectional study- surveying 295 pain physicians from across the United States asking about age, marital status, hours worked/week, months of behavioral health(BH) training, Burden of Difficult Encounters, Psychological Medicine Inventory and Maslach Burnout Inventory- with questions about the three pillars of burnout. Three multiple-linear regressions with emotional exhaustion(EE), depersonalization(DP), and personal accomplishment(PA) completed. Results: As expected, there were high levels of burnout amongst pain medicine physicians. A high level of EE reported in 44% and DP in 28%. PA is inversely correlated with burnout; 16% providers reported low sense of PA. Working more hours, more months of BH training, lower confidence in treating psychological profiles and greater burden of difficult encounters predicted greater EE. Lower confidence in the psychological aspects of care and greater burden of difficult patient encounters predicted greater DP. Being married, greater confidence in the psychological aspects of care, and lower perceived patient burden were associated with greater PA. Discussion: Chronic pain patients feel demoralized and frustrated. Pain medicine physicians are exhausted and burnt out. Evidently this is a complex population to work with and integration is an intuitive next step. Creating professional environments with high quality care expectations and physician confidence in managing complicated psychological profiles may help address burnout in pain medicine physicians. Chronic pain patients are inherently less responsive to procedures and narcotics; differentiating joint pain from brain pain and appropriately addressing both is key. Conclusion: Multidisciplinary approach includes two specific empirically validated psychological treatments for chronic pain: acceptance and commitment therapy and cognitive behavioral therapy. Both of which come with a toolbox for coping with pain, keeping personal valued goals in mind and learning to live with the pain vs. feeling like a victim of pain. This problem of how to deal with pain isn’t going anywhere. If drugs remain affordable, people will continue to turn to them, no matter how ineffective. At the heart of chronic pain remains the complex psychosocial aspects associated with living with chronic pain. Given the overlap between chronic pain and mental health, a promising treatment approach is to improve how we integrate psychiatry into pain management. Given the growing concern about the opioid epidemic and lack of data supporting the use of opioids for long-term pain management, these newer treatment approaches are necessary for better patient care outcome.
Patel, Vanessa, "Chronic pain: a disease of the brain" (2019). High Value Care. 5.