Can Rheumatologists Get More Systematic about Psychosocial Care?

Dr. Gerhart

His colleague James Gerhart, PhD, a clinical psychologist at Rush, is also involved in education of medical providers. “Everyone says we need to treat the whole patient. Of course it’s important, but okay, how do you actually do that in your practice? The first thing is to empower clinicians to say: I hear you. You’re in pain. I want to help you.”

The patient evaluation is itself an intervention—an opportunity to really hear patients, validate their symptoms and address their fears, he says. “If somebody is in pain, I also want to know about their sleep, about their level of functioning.” He encourages rheumatologists to be attentive and curious about these issues. Standardized screening tools should be integrated into the electronic medical record. He also encourages a warm hand-off to the pain psychologist with as much specific information as possible.

An Interdisciplinary Approach

Dr. Fillingim says the conversation about psychosocial pain care could be broadened to include advancing interdisciplinary care overall for pain. That goal is supported in the federal government’s 2016 National Pain Strategy, which endorsed comprehensive, interdisciplinary pain care delivered by integrated, patient-centered teams using a disease management model.⁵ “That means patients are getting all of the treatments that could benefit them, coordinated across disciplines,” he says. “We’re talking about psychosocial interventions designed to improve outcome, including quality of life and functional status.”

Unfortunately, when the doctor doesn’t have time to conduct a psychosocial intervention, it can be easier to just write a prescription for opioids Dr. O’Mahony says. “Paradoxically, insurance companies will pay for these medications that can have limited benefit and significant risk, but they won’t pay for proven psychosocial interventions,” or they charge prohibitively high copays.

Larry Beresford is a freelance medical journalist in Oakland, Calif.

References

1. Janke EA, Cheatle M, Keefe FJ, et al. Society of Behavioral Medicine (SBM) position statement: Improving access to psychosocial care for individuals with persistent pain: Supporting the National Pain Strategy’s call for interdisciplinary pain care. Transl Behav Med. 2018 Mar 1;8(2):305–308.
2. Sharpe L. Psychosocial management of chronic pain in patients with rheumatoid arthritis: Challenges and solutions. J Pain Res. 2016 Mar 14;9:137–146.
3. Majeed MH, Sudak DM. Cognitive behavioral therapy for chronic pain—One therapeutic approach for the opioid epidemic. J Psychiatr Pract. 2017 Nov;23(6):409–414.
4. Li LW, Harris RE, Tsodikov A, et al. Self-acupressure for older adults with symptomatic knee osteoarthritis: A randomized controlled trial. Arthritis Care Res (Hoboken). 2018 Feb;70(2):221–229.
5. National Institutes of Health. National Pain Strategy: A Comprehensive Population Health-Level Strategy for Pain. 2016.