The relationship between personality and pain can easily be traced to ancient Greece. In the late 19th century psychodynamic theorists saw a connection between emotional factors and the experience of chronic pain. Engel maintained that, while physical pain may result from pathophysiology, the interpretation of pain is a psychological phenomenon and that certain diagnoses were relatively common in people with chronic pain.
The 2019 Southern Pain Society (SPS) conference was held September 13-15 in New Orleans. We enjoyed reconnecting with previous conference attendees and meeting many first-time attendees. It was great to have a new attendee share that “this is great–so much better than I ever expected.” It would be difficult to find someone who didn’t learn at least a few new things.
In a post in a previous issue of this newsletter, titled “Gender disparities in Pain and Pain Care,” we explored the evidence that women are not only at higher risk for pain and pain conditions but that their pain appears to be underestimated and, in some cases, undertreated compared with men’s pain. Similar patterns are evident in diagnosis and treatment of pain in racial/ethnic/SES minority patients.
As a member of the Board of Directors of the Southern Pain Society, I want to share with the membership a recent workshop I presented to the Canadian Federation of Clinical Hypnosis in Banff, Canada. The workshop was titled “Hypnotically Enhanced Addictions Treatment: Drug Abuse, Alcoholism and Alcohol Abuse, Gambling Addiction, Smoking Cessation, and Obesity, with a Focus on Drug Dependence during this Opioid Crisis.”
“I just want my life back, I want to feel like me again”. This is a common refrain in our work as pain psychologists. Too often individuals with chronic pain feel as though their lives have fundamentally changed from ones defined by activity and engagement in a meaningful life to ones full of limitations, isolation, and feelings of loss.
In a widely-shared article published in the Atlantic in 2015, titled “How Doctors Take Women’s Pain Less Seriously,” author Joe Fassler tells of his wife Rachel’s visit to the ER after she is suddenly stricken with excruciating abdominal pain, later revealed to be a life-threatening ovarian torsion. . The article tells of their agonizing 14-hour wait in the ER while Rachel’s pain is dismissed, undertreated, and misdiagnosed.
All patients had the diagnosis of chronic migraine. Almost all patients had utilized Botox for their chronic migraine. Each patient had utilized at least 3 preventive medications in the past. Many of these patients remained on a daily preventive. Approximately 60% of the patients were considered to have refractory chronic migraine.
As a result of the opioid crisis, during the last few years we have faced many changes that we never expected. Patients and families have been devastated. Some are dealing with Opioid Use Disorder, while others are dealing with pain and withdrawal after abruptly stopping prescription opioids. Shocking are notes posted on physician’s doors stating: “We do not prescribe opioids.”
The members of the Board of Directors of the Southern Pain Society were saddened to read about the possible need for the American Pain Society to cease operations. We have long appreciated the scientific contributions and clinical guidelines for pain management made by the APS.
Thinking about our coming Annual Meeting, I’m reminded of the complexity of the challenges we face. Along with the attention the opioid crisis is receiving, those of us working daily with patients living with pain know that for many of them there is a simultaneous pain crisis. As pain professionals we have a responsibility to help to “clean up” what many consider to be “the mess” that resulted from the opioid crisis and now the consequential pain crisis.