Psychosocial care focuses on psychological, behavioral, cultural and social contributors to the pain experience, especially when a purely pharmacologic (or physical) approach has failed to relieve a patient’s pain. “When we talk about psychosocial care, we’re talking about treating the whole person,” says Amy Janke, PhD, the SBM report’s lead author and interim chair in the Department of Behavioral and Social Sciences at the University of the Sciences in Philadelphia.
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Explore This IssueJune 2018
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Psychosocial interventions for pain can include cognitive behavioral therapy, a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem solving and skills teaching. Its goal: To change patterns of thinking or behavior behind people’s difficulties and, thereby, change the way they feel.
Other techniques to enhance the mind’s impact on the body include mindfulness meditation, yoga, guided imagery, biofeedback, hypnosis, tai chi and prayer. The multidisciplinary approach to psychosocial, whole-
person care can be integrated with a variety of opioid-sparing complementary and alternative therapies. Support for this approach comes from a study in Arthritis Care & Research that demonstrated benefits of self-administered acupressure in osteoarthritis, which was shown to be superior to usual care in pain relief and for physical function improvement.4
“One thing we’ve learned through the current opioid public health crisis is that if we take one approach only in treating pain, we can fail a lot of patients. It’s critical that we think about the individual in pain from a more whole-person perspective,” Dr. Janke says. What are their coping methods, their social circumstances? What is their state of mind? What are they thinking about their pain? Not all of those factors may be in play for every patient, but caregivers should address all in every patient encounter.
“On one hand, we want to encourage a psychosocial mindset by medical providers. But the responsibility for psychosocial care shouldn’t land solely on the rheumatologist,” Dr. Janke adds. “Too often, we put providers in a position of having to do everything in their 10–17 minute encounter with the patient. But we can ask them to think more about their patients’ pain from a psychosocial standpoint,” she says.
“Rheumatologists already do this, but our report is saying it should be named and systematized,” she says. “If my patient is struggling with comorbid stress or anxiety, which can exacerbate pain, maybe they need more help managing that—and in getting a psychosocial intervention.”
Rheumatologists, who try so hard to relieve suffering, are now seeing the demonization of what has been at times a useful tool—opioid analgesics—while other tools of demonstrable value are not necessarily accessible, depending on the setting, the resources of their health system or medical group, and what is reimbursed, she said.
Can Patients Participate in Their Own Care?
A greater emphasis on psychosocial care starts with a change in treatment philosophy to require the patient’s active participation, Dr. Fillingim says. “That may be news to many patients.”