The recent Journal of Practical Psychiatry has a paper of cognitive behavioral therapy (CBT) for chronic pain. Basically, they say that there is emotional and psychiatric factors in the patient with chronic pain, and there is sometimes more fear for the pain than the pain itself that is debilitating. CBT challenges the inner thoughts and belief of the pain in the patients. With CBT treatments, the patients are in a better situation of stepping out of the inactivity and de-conditioning that are from the fear of pain. The authors claim that CBT may help with the opioid epidemic.
Why pill is necessary?
When a patient starts opioid, both the doctor and the patient consider it is the only way of achieving pain control and more importantly the functionality. From the physician’s perspective, the risk of dependence versus the benefit of achieving pain relief is always balanced. The pain is real, chemical, and has to be fought back chemically.
Can people wait to cure slowly?
However, in the article there is not much about how to learn the technique to fight pain. It is more about how to get more business for psychiatrist to work as gatekeeper for pain management. Again, back to the feasibility of talking pain away. If it is real, it takes time to learn and adapt the technique psychologically. People lose their jobs because of pain, lose their life because of cancer and pain, lose their functionality and limbs because of peripheral neuropathy. All of these takes no time.
It works for fibromyalgia?
For fibromyalgia, which is chronic pain with mental factors, CBT may improve the coping skills. But realistically, sorry psychiatrists, people are reluctant to go there and deemed as mentally sick. If somebody tells them that they are actually crazy, the real pain in no matter body or brain would drive it worse. This is exactly what doctors should avoid in the treatment of fibromyalgia.
Integrative medicine works.
Pain management nowadays is more and more in a integrative way: mindfulness, relaxation, alternative medicine and physical therapy. Integrative medicine even has homeopathy, which others don’t have the mastery. To give an example, for post-surgical pain with feeling of removed testis or ovary, homeopathy has long history of success. Most importantly, pain management is medicine. Knowing medicine inside out and knowing the patient really well are the fundamentals for a integrative medical doctor to deploy his strategy.