The PILL, like other psychological tests, is relatively simple (you can take it online yourself in a few minutes at http://counsellingresource.com/quizzes/pill/index.html) and illuminates a patient’s tendency to experience symptoms. Like measures of this kind, the PILL can help construct a cognitive framework for clinical decision making. The PILL is not for diagnosis. Just as the finding of an elevated sedimentation rate influences choices during a diagnostic workup, an elevated score on the PILL can help a clinician determine, for example, the meaning of the headaches, myalgias, abdominal pains, and rashes that so often beleaguer patients with chronic pain.
From my brief (and nonexpert) review of this literature, I think that creating a psychological profile of a patient with the PILL could add value in the management of rheumatologic conditions other than fibromyalgia. Lupus has its share of fibromyalgia manifestations. I would also wager than at least some patients with rheumatoid arthritis who fail to respond to current disease-modifying agents actually have a pain syndrome rather than jazzed-up B cells or macrophages promiscuously stimulating T cells.
The treatment of pain is inextricably tied to rheumatologic practice, and I look forward to a very exciting time as the ACR moves decisively into this rapidly moving field.
Focus on the Person in Personalized Medicine
Modern medicine is about to enter an era of personalized care. According to the precepts guiding this movement, a battery of genetic, genomic, proteomic, and metabolomic tests—using whiz-bang chips loaded with bells and whistles despite their small size—have the power to predict a patient’s susceptibility to disease, along with everything else from the response to therapy to the likelihood of complications. As current research is showing, however, the goal of personalized medicine may not be easy to achieve even with cutting-edge technology sharpened like a razor. Genetic variation in the population is huge—maybe too huge. As a result, determining genetic susceptibility factors in an individual or population is far from a slam dunk. Results from “omic” technology may also be inconsistent, varying with the time of the day or the month or what you had last night for dinner.
Given the complexity of molecular studies, I think that, in the near term, the use of psychological tests like the PILL, along with other off-the-shelf indices, is eminently reasonable and unequivocally puts the person center stage in personalized medicine.
The future of the science of pain and its management is very bright. Under the leadership of incoming President David Borenstein, MD, the ACR is doing a great job of positioning pain as a focus of inquiry, with its management ready for programs of quality improvement. I have been privileged to be part of this important initiative. The treatment of pain is inextricably tied to rheumatologic practice, and I look forward to a very exciting time as the ACR moves decisively into this rapidly moving field.
