There is so much overlap between chronic pain, depression, anxiety, and PTSD. When people come through your pain program with multiple comorbidities like that, are you aiming to address all of those at once?
Our program focuses on pain rehabilitation; however, the vast majority - well over 90% of our patients have some kind of psychiatric comorbidity, whether it is depression, anxiety and a large part of these have PTSD. And we know individuals who have been exposed to trauma are more vulnerable to developing issues with chronic pain.
There are a few things that are important to mention with that:
We see individuals for CBT who are not ready to engage in treatment for PTSD issues. It may be too challenging to engage in that treatment. We find that a lot of the work we do to address chronic pain has an overlap with PTSD as well. The hallmark of both pain and PTSD is avoidance.
What we are really talking about is approach – how do we approach these issues in a gradual way so we start to see that this is not going to be harmful, and that it is actually going to help a bit? If we work on the approach piece, we are not only going to help pain-related symptoms, but also PTSD-related symptoms. This is something we are able to see in our treatment.
Are there any stories of drastic transformations that stick out in your mind?
I’ve seen so many transformations that have been so inspiring to me. I think the ones that stick out tend to be the ones that tend to be some of the more extreme cases; for instance, a man who is 60 who is a Vietnam-era veteran who has never sufficiently addressed his PTSD symptoms or chronic pain. This is somebody who has been masking all of these symptoms with alcohol and then opioids. He was not using alcohol by the time I saw him, but had transitioned from numbing with alcohol to numbing with a high dosage of opioids. He was having a lot of difficulties, particularly in his marriage. This is something we see on a somewhat regular basis where there is really fractured relationships around opioids.
He agreed to come into the program and called me before his admission date tearful because he was so worried about what was going to happen and about his pain level. I’m sure he had a lot of other concerns as well.
At first, he had a rocky time in our program, but we were able to offer that high level of support to him. One thing that we do see sometimes is that once we start tapering off of medication, there can be more of an awareness of the more psychiatric symptoms that had been masked from opioid medications. We spent a lot of time discussing PTSD-related symptoms.
By the second week of our program, he was interacting like a different person. By the end he reported how grateful and clear-headed he was. He went into more intensive PTSD treatment, and he requested to come back as a champion for the program.
[this is an excerpt only - for the full episode, listen to the podcast at the link above]