Biopsychosocial Pain Medicine: Integrating Psychiatric and Behavioral Therapies into Medical Treatment

Successful management of chronic pain disorders and diseases starts with an appreciation of the many biological and psychosocial factors, including pain generators and comorbidities, that may affect outcome. Choosing the appropriate treatment for any one patient hinges on a careful assessment of these factors and a reasoned and feasible outcomes-oriented treatment plan that controls as much of the variance as possible. Chronic pain, a coping challenge for everyone, causes some psychosocial problems for everyone and clinically significant psychiatric disorder in many. Or, chronic pain onset can worsen preexisting psychosocial problems and psychiatric disorders. Simple screening questions are highly sensitive, missing few cases. Specific diagnosis requires a more detailed interview. Suicide is the most common mortal complication of chronic pain, particularly with comorbid depression, and should be asked about routinely. Depression, anxiety disorders, and substance abuse are the most common complicating psychiatric comorbidities. These should be identified and managed to achieve optimal surgical outcomes. A plethora of effective medications, some for specific depression and anxiety disorder diagnoses, are available. Substance abuse and addiction are more difficult and may require special treatments. Skillfully treating both pain and psychiatric comorbidity leads to the best functional outcomes for the person in pain.