Pain Management Using a Biopsychosocial Perspective

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Reviews the video, Pain Management with Robert Gatchel (2006). A recent nationwide survey of approximately 25,000 working Americans revealed that, at any point in time, 25 percent experience some type of chronic pain complaint. Chronic pain is a universal problem, as an estimated 80 percent of the U.S. population will suffer from back pain at least once, which makes it the second most common reason for seeing a doctor, following coughs and other respiratory infections. It is fair to say that the major breakthrough in the field of chronic pain has been the introduction of cognitive and behavioral treatments. Newer approaches to chronic pain management incorporate mindfulness, acceptance, and value-based motivational interventions (Robinson, Wicksell, & Olsson, 2005). Currently, most interdisciplinary pain treatment centers provide psychological services as a core element of pain management. It was thus with much anticipation that I viewed the videotape Pain Management, with Robert Gatchel as the resident expert, hosted and moderated by Jon Carlson. The video is composed of three parts: an introductory discussion, a clinical demonstration, and a question and answer segment. The first part of the tape involves an introductory discussion of why chronic pain is a problem that psychologists must be prepared to treat (i.e., it is a nearly universal problem, cognitive and behavioral treatments work, and it is highly comorbid with mental health conditions and addictions) and how to best conceptualize the problem of chronic pain. The bulk of the tape is a clinical interview involving Gatchel and a middle-aged woman diagnosed with fibromyalgia. Gatchel does a superb job of demonstrating a biopsychosocial assessment with this patient and effortlessly glides among domains. The clinical demonstration is followed by a debriefing question and answer session between Carlson and Gatchel in which they deconstruct smaller parts of the original interview (30- to 120-second segments). Gatchel makes some other points during this segment that I think highlight the general difficulties we are having as a country in addressing the needs of patients with chronic pain.

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