Objectives:
To introduce psychiatry residents to the psychological and psychiatric co-morbidities of patients with chronic pain, referred to a tertiary multidisciplinary pain centre.
At the completion of the rotation, the resident will have the competence to:
- Learn to evaluate the pain problem (medical and psychiatric aspects)
- Acquire knowledge of the main medications used in the treatment of chronic pain
- Learn clinical skills necessary for the assessment of the chronic pain patient
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- Pain assessment tools including factors biasing pain measurement
- Clinical assessment including history, laboratory investigations and psychosocial/psychiatric evaluation
- Learn basic aspects of chronic pain management
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- Pharmacotherapy
- Physical therapies
- Psychological techniques
- Learn possible problems of chronic drug use
- Understand the psycho-social aspects of chronic pain
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- Understand the multifactorial etiology of chronic pain
- Understand variability of the pain experience
- Understand widespread impact of chronic pain on all aspects of life
- Understand expectations of chronic pain patients of the Pain Management Unit
- Understand special problems of caring for the chronic pain patient
- Recognition of the limits of pain medicine
- Recognition of the effect of emotional distress, cognitive dysfunction, and malingering on the presentation and success of pain therapy
- Recognition of the importance of physicians’ reactions to chronic pain patients (i.e. countertransference) in the doctor-patient relationship
- Learn to identify DSM IV-R disorders in patients with chronic pain
- Learn to distinguish between pre-morbid and secondary psychological/psychiatric disturbance
- Understand the reciprocal relationship between pain and psychological/ psychiatric problems
- Be aware of obstacles to successful treatment of pain
- Know psychotherapy methods for treating patients with pain
The intent of the rotation is to integrate the resident into all aspects of the activities of Alan Edwards Pain Management Unit. As such, residents will be expected to attend all clinical and academic rounds in addition to their participation in the scheduled patient care.
Reading on pain for residents in psychiatry
- Turk, D.C. and Gatchel, R.J. (Eds.) Psychological Approaches to Pain Management, Guilford Press, N.Y. 2002 (book available at Pain Centre)
- Ch. 1: Psychosocial Perspective on Chronic Pain
- Ch. 4: Enhancing Motivation to Change in Pain Treatment
- Ch. 5: Integrating Relational Psychodynamic and Action-Oriented Psychotherapies: Treating Patients and Suffering
- Ch. 13: Integration of Pharmacotherapy with Psychological Treatment in Chronic Pain
- A Virtual Pocket Dictionary of Pain Terms
Optional readings
- Nicholas, M., Molloy, A., Tonkin, L.., Beeston, L. Manage your Pain, ABC Books, Sydney, Australia, 2000.
- Turk, D.C. & Gatchel, R.J. All chapters not listed above
