A new paper (on-line only at the moment) (1) reports a prospective epidemiological study that examines the association between Adverse Childhood Experiences (ACEs) and the subsequent occurrence of painful medical conditions. The role that mood and anxiety disorders play in this association is also carefully assessed.
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ACEs and the Epidemiology of Psychophysiologic Disorders
June 8th, 2017Psychophysiologic Disorders and Social Change in Medicine
March 5th, 2017Michael Galinsky, a director of and a principal subject in a documentary about chronic pain titled All The Rage has written a wonderful essay (1) on the process of physicians changing their practice (or not) in response to research data. Any one interested in how treatment of chronic pain and other symptoms linked to psychophysiologic disorders will evolve (or not) in coming years will find it clearly written and edifying.
Major Change in Financial Incentives for Care of Psychophysiologic Disorders (PPD)
February 13th, 2017A major change in the financial incentives for care of Psychophysiologic Disorders (PPD) has just occurred in the United States (1). The case for integrating both medical and mental health care into primary care has always been compelling. Now, in 2017, the U.S. Medicare/Medicaid system has decided it will pay for a form of care that is strongly aligned with this concept (more on that below).
The Dawn of Integrated Care for Psychophysiologic Disorders (PPD)
September 1st, 2016A paper published in 2014 (1) is getting a lot of attention now because of the following conclusions (italics mine): Read the rest of this entry »
What Will Replace Opiates?
March 27th, 2016Prescription opiate medication for chronic pain is a treatment whose time is ending. To quote Dr. Tom Frieden, director of the Center for Disease Control (CDC), for most pain patients the benefits of opiate painkillers are “unproven and transient” and they can be “just as addictive as heroin.” In addition, annually since 1999, ten thousand people have died from overdoses of prescription painkillers. The pain management community has concluded that, apart from people with cancer pain or those at the end of life, opiate painkillers have become a public health crisis. The CDC now recommends against using them for most non-cancer patients.
Psychophysiologic Disorders and Controlled Research
November 14th, 2015Acceptance by the health care profession that Psychophysiologic Disorders (PPD) can be successfully diagnosed and treated will depend on completion of at least two randomized controlled trials (RCT). The RCT is the gold standard method for documenting that a new form of treatment is superior to a placebo. Only when a treatment passes this test and that passing is then confirmed by at least one additional RCT will clinicians consider making the effort to apply it to their patients.
Patients Who Have “Nothing the Matter with Them”
June 9th, 2015Among physicians with a humanistic soul, perhaps no quotation is more fondly remembered than one from Dr Francis Peabody. He was born in 1881 to a prominent New England family, trained at Harvard and Massachusetts General Hospital and was the first director of the Thorndike Laboratory at Boston City Hospital. Tragically, he died of sarcoma at age 46.
One Approach to Psychophysiologic Disorders
May 31st, 2015Recent on-line and in-person discussions with my colleagues who care for patients with Psychophysiologic Disorders (PPD) make it clear that there are many successful approaches to diagnosis and treatment. What these techniques have in common is clarifying for patients that psychosocial stress can cause real pain and/or other physical symptoms and that uncovering and treating these issues can relieve the illness (partially or completely). Our discussion led me to summarize my approach: Read the rest of this entry »
A Physiologic Basis for Fibromyalgia
March 24th, 2015A study of the brain (published on-line Jan 2015) has uncovered an important difference in the processing of pain signals between people with fibromyalgia (FM) and those without FM.(1) Participants with FM had brain imaging with functional magnetic resonance (fMRI) while a blood pressure cuff on their leg created pain at a level (determined by each person) of 40 out of 100.
