SCE Pittsburgh: Holistic approach, healthy discussions facilitate chronic pain treatment

To explain his approach to the treatment of chronic pain to attendees at the Summit for Clinical Excellence event Monday in Pittsburgh, Gregory Hobelmann, MD, MPH, compared pain recovery to responding to a house fire. Like putting out the fire itself, reducing physical pain must be part of the plan—but not the entire plan, Hobelmann said. In much the same way that loved ones need to be evacuated from the building and valuables should be secured before they are claimed by the blaze, pain recovery also needs to account for additional effects.

“If you look to treat just the physical pain, you are missing pieces—the cognitive effects, the emotional effects and the spiritual effects that we know occur along with chronic pain,” said Hobelmann, chief medical officer for Ashley Addiction Treatment. “If we’re addressing the physical component only, patients are not necessarily going to see robust improvement in their emotional and cognitive defects that they’ve developed. You want to look at the whole person and treat all of those things at once.”

Hobelmann emphasized the importance of re-establishing patients’ self-efficacy, instilling in patients the belief that they can retake control of their lives.

“If we can give them a better understanding that what I do and the way I think and behave is going to play a huge role on the outcomes, it increases the self-efficacy when they see that start to work,” Hobelmann said. “It not only increases their self-efficacy, it helps them develop a new identity as a person with meaning and hope.”

Hobelmann also listed potential landmines lurking in discussions between practitioners and chronic pain patients that can be counterproductive, ultimately increasing shame in patients instead of creating a supportive environment for recovery:

• Whether pain is real or fake. Pain is a subjective experience, Hobelmann said, and it might affect one person more physically and another more emotionally or cognitively.
• Addiction vs. dependency. The debate over whether a patient has an addiction to or dependency on pain medication is an ineffective argument, Hobelmann said. Instead, shift the focus toward building consensus with the patient on what is in the patient’s best interests for managing their chronic pain moving forward.
• Implications of laziness or dishonesty. “You don’t want to talk about that you’re ... in this condition because it gets you out of work or you’re getting money or you’re lazy or anything like that,” Hobelmann said. “Those things, even though there are those secondary gains, they’re not intentional in the vast majority of cases. Ignore it and let those go.”