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Chronic Pain and Addiction at Psych Congress 2020

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This year the Psych Congress was different because it was virtual. Although I am sure that most of my colleagues were missing the experience of mingling with the colleagues in between sessions and exchanging ideas about patient care, the quality of the sessions, as well as the topics that were covered, were remarkable. The conference featured topics such as treatment across the lifespan, addiction, and phase II and III trials for new pharmacological treatments. Among many excellent lectures, I was particularly interested in the topic of chronic pain and addiction. The session I attended explored protocols that offered clear-cut pathways for rational care in complex cases.

Misuse of prescription opioids has been a major public health concern in the U.S. as the prevalence of misuse has been consistently rising since the late 1990s, resulting in thousands of opioid-related deaths. According to a 2015 National Survey on Drug Use and Health, 91.8 million adults in the U.S. are using prescription opioids. Among them, 11.5 million misused the drugs, while 1.9 million had developed substance use disorder. In this survey, the respondents indicated that their main motivation for the misuse of the drugs was physical pain relief. In addition, results of this survey found that people who were socioeconomically disadvantaged or had mental health problems were at a greater risk of aberrant behavior. Furthermore, the survey indicated that 59.9% of the respondents had used opioids without prescription while 40.8% obtained free prescriptions from family and friends. 

Chronic pain affects the quality of life and socio-economic activities of millions of Americans. Though there is no definitive cure for chronic non-cancer pain, research suggests a multidisciplinary pain program approach. Usually, multidisciplinary pain management approaches are developed along with a bio-psycho-social model of chronic non-cancer pain. Multidisciplinary care is essentially transformative care as it incorporates comprehensive, patient-centered self-management strategies with evidence-based treatments as routine care for various chronic pain conditions, and ensures that consequences are effectively prevented and managed. There are several options for chronic pain treatment. These approaches can be categorized as physical medicine, behavioral medicine, neuromodulation, pharmacologic, interventional, and surgical approaches. For optimal patient outcomes, multiple approaches coordinated by a multidisciplinary team should be implemented. Collaborative care models were found to improve pain management and patient outcomes. This implies that a successful model should not focus solely on medication but should include other treatment modalities to meet treatment goals. Furthermore, patients with chronic pain require regular evaluation, education, and reassurance, as well as setting reasonable expectations for response. The collaborative model was also found to improve the patient's quality of life, both physically and emotionally. The collaborative model also offers flexibility that allows other models to be incorporated, thus enhancing the effectiveness of pain management strategy, especially when using opioids.

This kind of transformative care significantly improves long-term outcomes and reduces the dependence of the patient on the health care system, thereby leading to improvement of both the patient’s life and health care system. For this reason, health leaders should always strive for the integration of self-management strategies into a clinical practice that aims at engaging, educating, and empowering people to prevent chronic pain and addiction. 

Illustration by April Brust

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