Response to “Treat the Abyss” From the Roundtable

In response to some things said at the roundtable, I want say a few things about the emotional aspects of chronic pain treatment–namely, the additional stress caused by worker’s comp, the underlying anger of chronic pain, and the stigma of psychological diagnosis.

Most people have a lot on their plate and stress is a big issue in our society right now.  The additional stresses of not only being unable to fend for yourself in a capitalistic society plus the unending additional stresses of dealing with a worker’s comp claim would stress out almost anyone.  In the context of chronic pain, the additional stress will actually increase their actual perception of pain.  This is a huge barrier to recovery.

An accurate diagnosis is important.  But the reality is that if you have to “buy a diagnosis” in order to enable treatment, then the worker really does not have access to mental health professionals to make the correct diagnosis.  My point is that the system must recognize the additional stress that it puts on the patient and help them through it.  Full mental treatment for a given patient is just a fraction of the cost of a procedure or a test.  Much of it could also be done in a group setting.

I also feel that engaging the worker is key.  The education is a significant part of it. That is essentially what I do–educate, support, and guide a patient back to health.  The vast majority of the success is from the effort of the patient.  Once a given patient understands the various aspects of their pain experience and some of the solutions, they brighten up and engage in the treatment.  The biggest block I consistently see is anger.  An angry patient is not rational and cannot receive the input they need to move forward.  I occasionally can wear them down, as I never give up, but I often do not know how to break through that barrier.

In regards to mental health treatment, the stigma of a psychiatric diagnosis is genuine.  I have watched multiple colleagues stigmatized in many ways, and I have experienced it myself.  It is curious to me why our society is that way when there are such a high percentage of people with some sort of mental health diagnosis.  One in five women have an eating disorder.  Thirty percent of the population has either a major of minor depression.  The list is endless.

I think that the terminology of “emotional aspects of injury” might be useful for the roundtable to look at and possibly push the system to help these stressed injured workers.  If this group could organize some type effort, I think we could make a major contribution to injured workers and society.