Biopsychosocial Model Effective for Patients with Comorbid Pain

By Worcester, Sharon | Clinical Psychiatry News, February 2007 | Go to article overview

Biopsychosocial Model Effective for Patients with Comorbid Pain


Worcester, Sharon, Clinical Psychiatry News


ATLANTA -- A biopsychosocial approach may offer the most effective way to manage chronic pain in patients with a comorbid mood or substance use disorder without compromising recovery processes, Martin D. Cheatle, Ph.D., said at the Southeastern conference on alcohol and drug addiction.

The key is treating the whole patient, and treating the disorders concurrently rather than sequentially. A patient who goes through detox but goes home in pain is at high risk for returning to narcotics abuse, and the effects of depression and anxiety on pain and treatment outcomes, and vice versa, also have to be considered, said Dr. Cheatle of the Behavioral Medicine Center, Reading (Pa.) Hospital and Medical Center.

The biopsychosocial model involves the use of evidence-based medication management along with cognitive-behavioral therapy and an exercise/physical therapy program with a goal of empowering the patient to take charge of the pain. Relaxation and thought focus techniques, and development of adaptive resources such as coping skills, strength, and stamina can help in providing that empowerment.

Also key to success is community support via a network of specially trained primary care doctors and specialists working together in the patient's interest.

Programs incorporating this approach have been shown to improve treatment outcomes, promote return to gainful employment, reduce pain, and increase functionality. For example, a study of 123 patients at the Behavioral Medicine Center showed that from admission to 1.5 years following completion of a 3-week residential behaviorally based pain program including rehabilitation and group cognitive-behavioral therapy, the use of opioids, benzodiazepines, nonsteroidal anti-inflammatories, and antidepressants dropped dramatically, and the use of over-the-counter treatments for pain increased. …

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