As we head into the summer months, we consider a better approach to chronic pain, explore idiopathic hypersomnia, and wonder about the practice of deprescribing.
Tailored, Whole-Person Care Offers Hope for Chronic Pain
A tricky case of chronic pain — appearing this week in The Primary Care Companion for CNS Disorders — has revived interest in developing multimodal, opioid-free strategies for effective pain management. The case is especially relevant for patients living with comorbid medical and psychiatric conditions.
Ms. C, a 56-year-old woman with obesity, fibromyalgia, diabetes, PTSD, and severe osteoarthritis, has endured chronic pain since a major car accident 10 years earlier. Her pain, exacerbated by grief and isolation, led to multiple emergency department visits and short-term opioid prescriptions. And like a lot of patients with chronic pain, her story shows how traditional approaches usually fail if they don’t address the underlying conditions.
There are those who advocate a pivot away from opioid-heavy strategies toward a more nuanced, patient-centered model. This can include a comprehensive evaluation of the physical, emotional, and psychological components of pain, along with a tailored plan that balances pharmacologic and nonpharmacologic therapies. Tools such as the WHO analgesic ladder and biopsychosocial models guide care that can include duloxetine, physical therapy, mindfulness, and weight management..
The stigma that clings to chronic pain — especially among women — can lead to inadequate treatment, misdiagnosis, and (as a result) deteriorating outcomes. Patients like Ms. C frequently run into skeptic providers. This can force patients to internalize their shame or even avoid care altogether. And that can lead to further deterioration in one’s health and their quality of life.
Ms. C’s condition improved with the implementation of a holistic plan that included medication changes, behavioral therapy, and non-opioid alternatives. Her story echoes a broader call for integrated care models that address pain while minimizing stigma, which helps patients take back their lives.
IN OTHER PSYCHIATRY AND NEUROLOGY NEWS
- A new review in The Journal of Clinical Psychiatry discusses idiopathic hypersomnia and psychiatric disorders and their complex, likely bidirectional, relationship.
- PCC published a case report this week about a man with severe hypertension, hyperthyroidism, and stimulant use who presented to the ED with headache, nausea, dizziness, and visual disturbances.
- Additional JCP research reveals that peripheral vestibular disorders are a risk factor for dementia, regardless of the psychiatric comorbidities at play.
- A new PCC review explores the link between hydroxychloroquine and psychiatric side effects such as anxiety, depression, and psychosis.
- Finally, we close out this week with the answer to a simple question: What is deprescribing?
