There, my program director introduced us to a new concept: How about considering the patient as a whole, rather than focusing exclusively on the area where the pain seemed to be originating? This philosophy of medicine, called the biopsychosocial model, is based on the premise that emotions, thoughts, and cultural biases all play integral roles in a person’s disease and his or her ability to function in society. And in order to treat a patient effectively, all of these issues must be addressed. For chronic pain, this means understanding how a person’s pain influences her emotional state and ability to get through the day, work and interact with others, and more. Then these issues can be addressed as part of a larger problem that includes but is not limited to the pain.
Yoga Workout For Lower Back Pain Photo Gallery
While the biopsychosocial model had been around for decades, during my fellowship the idea of applying it to the treatment of pain was still novel. And there were problems, which still remain today. Academic training centers are notorious for neglecting to provide long-term patient follow-up. Fellows are very busy mastering high-tech procedures and spinal implants, and the proper use of designer medications, so they don’t have much time to think about their patients’ health and wellbeing over the long term And even if a fellow does happen to be curious about the long-term effects of the medicines, procedures, and surgeries, she may only see a given patient for a few weeks or months before she moves on or the patient does. So if a fellow prescribes a new medication or injection today, he will never really know how it might affect that patient a year or two down the road. As a result, doctors in pain management are not trained to think in terms of long-term outcomes or the big picture. And neither was I.
Shortly after my training was completed in 1996, I opened a pain management practice. My new practice offered patients the most up-do-date medicines, injections, and procedures, as well as special spinal implants. Since I was the new, young “whiz kid” with a fellowship in a brand-new specialty, other doctors sent me patients with complex pain problems that they couldn’t solve. These doctors evidently expected me to pull some sort of rabbit out of a hat that could eliminate the pain— and the patients were desperate for me to do so. I would have liked to apply the biopsychosocial model that made so much sense in school, but it didn’t seem to exist in the real world. Typically, the patients weren’t receptive to it. “I have real pain; I’m not crazy,” they would say. The other doctors didn’t support it because my approach was nontraditional, and the insurance companies usually refused to cover my comprehensive approach. Nobody wanted a new model of healthcare; they just wanted me to do something to fix the problem as quickly as possible. In short, the biopsychosocial model had strong support in the halls of academia, but it didn’t seem to be feasible in everyday practice.
Practice What You Preach
It wasn’t just my observations of patients whom we failed to help that gave me pause. I was also struggling through my own experience with pain. I had long been an enthusiastic athlete, suffering the usual injuries. In my late twenties, I tore the ACL (anterior cruciate ligament) in my right knee while playing soccer. Luckily, with the help of surgery and rehabilitation, I recovered. But a few years later, after completing my medical training, I tore just about every ligament in the same knee while playing basketball. This time I didn’t bounce right back after surgery, and the pain refused to go away. Medications were of little help and left me feeling sick to my stomach. I couldn’t get a good night’s sleep because every time I turned over in bed, the pain woke me up.
But since I was self-employed, I felt I had to return to work immediately; my family, employees, and patients were depending on me. I’d struggle through the day on crutches that made my armpits perpetually sore, ignoring the knee pain, and returning home at night with a very swollen right leg.
Just getting around was a problem; I felt trapped in my own body. Soon, I realized I was forgetting things. A patient, a nurse, or my wife would tell me something, and fifteen minutes later I would forget it. Due to the ongoing pain, difficulty sleeping and getting around, plus constipation and other side effects of the medicine I was taking, I soon became depressed. And hearing about other people’s pain, or watching the news and seeing the terrible things that were happening around the world, just seemed to increase my own pain.
I was going through what many of the patients had complained to me about: Above and beyond the pain, which was bad enough, I was suffering from forgetfulness, trouble focusing, depression, pain in other parts of my body, and medication side effects. I was putting on weight and my cholesterol went through the roof. I began to despair, fearing that I would never recover; my life was coming apart. In the past, I had always listened sympathetically to my patients, but I didn’t understand what it was like to be in their shoes. Now it was happening to me; my pain was taking over my own life. I thought, “There must be a way to work myself out of this!” And there was. My pain led me on a journey that turned out to be my greatest medical learning experience.
At that time, articles in the medical journals focused on managing pain symptoms, and researchers looked for new medications and pathways that could better manage these symptoms. But neither the articles nor the researchers offered any recipes for bettering the lives of the patients sitting in front of me in my office.
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