In Pain Management, Dr. Robert J. Gatchel shows how his biopsychosocial approach to treating clients with pain can uncover the complex factors that create pain. Every client experiences pain differently, so it is important to do a thorough assessment that covers physiological, social, and psychological facets of a client before recommending a course of treatment.
In this session, Dr. Gatchel works with a 59-year-old woman, first evaluating her psychological and medical status to determine the causes of her pain and then helping her with the anxiety she feels about the pain.
Sharon was diagnosed with fibromyalgia 4 years ago. Over the past 10 years, she has experienced symptoms such as fatigue, pain in various parts of her body, numbness and tingling in her arms, and forgetfulness. She is currently taking Eflexor, Ultrem, Neurontrim, and Tylenol 3.
A biopsychosocial approach was taken in the assessment of this patient. This approach, which is the most heuristic perspective of pain, assumes that pain is a complex and dynamic interaction among physiological, psychological, and social factors that often results in, or at least maintains, pain and disability. It cannot be broken down into distinct, independent psychosocial or physical components. Therefore, a comprehensive history-taking of biopsychosocial factors that may be involved in the pain perception process must be obtained to understand how it is experienced uniquely by the patient.
This initial information then serves as the "stepping stone" to determine what additional assessment or diagnostic tests need to be conducted. Of course, at the outset, the pain severity of the patient needs to be documented using a pain scale (which was completed before this interview). Indeed, the Joint Commission on Accreditation of Health Care Organizations now requires that health care professionals consider pain as a "fifth vital sign" (added to pulse, blood pressure, core temperature, and respiration) when evaluating patients.
The following assessments also must be made: the patient's own words describing the pain; pain location, duration, aggravating and alleviating factors; present pain management regimen and its effectiveness; effects of pain on activities of daily living; the patient's pain-related goals; and the physical examination.
During this interview, Dr. Gatchel attempted to initially evaluate the overall mental and psychosocial status of the patient, as well as any possible antecedent and secondary variables contributing to the pain. Such information is helpful in understanding what more specific assessment protocols may need to be administered before determining a possible treatment strategy. In addition, an effort was made to help alleviate some of the fear and uncertainty associated with the patient's current pain condition.
Robert J. Gatchel received his PhD in clinical psychology from the University of Wisconsin in 1973. He is currently Elizabeth H. Penn Professor of Clinical Psychology and professor in the Department of Psychiatry and the Department of Rehabilitation Science at the University of Texas Southwestern Medical Center at Dallas, where he is director of Graduate Research, Division of Clinical Psychology. Dr. Gatchel is also the program director of the Eugene McDermott Center for Pain Management at this medical center.
He is a diplomate of the American Board of Professional Psychology and is on the board of directors of the American Board of Health Psychology. He has conducted extensive clinical research, much of it supported by grants from the National Institutes of Health (NIH), on the psychophysiology of stress and emotion; the comorbidity of psychological and physical health disorders; and the etiology, assessment, and treatment of chronic stress and pain behavior. He is also the recipient of consecutive Research Scientist Development Awards from the NIH.
Dr. Gatchel has published more than 190 scientific articles, 60 book chapters, and 21 books, including Clinical Essentials of Pain Management (American Psychological Association [APA], 2005); Clinical Health Psychology and Primary Care: Practical Advice and Clinical Guidance for Successful Collaboration (with M. Oordt; APA, 2003); Personality Characteristics of Patients With Pain (with J. Weisberg; APA, 2000); Psychophysiological Disorders: Research and Clinical Applications (with E. Blanchard; APA, 1993; re-released 1998); Psychological Approaches to Pain Management: A Practitioner's Handbook, Second Edition (with D. Turk; 2002); and Psychosocial Factors in Pain: Critical Perspectives (with D. Turk, 1999).
Most recently, he was the first psychologist to receive the prestigious Henry Farfan Award for Outstanding Contributions to the Field of Spine Care from the North American Spine Society, as well as the recipient of the Award for Outstanding Contributions to the Academy of Behavioral Medicine Research.
- Gatchel, R. J. (2001). A biopsychosocial overview of pre-treatment screening of patients with pain. The Clinical Journal of Pain, 17, 192–199.
- Gatchel, R. J. (2005). Clinical essentials of pain management. Washington, DC: American Psychological Association.
- Gatchel, R. J., & Oordt, M. S. (2003). Clinical health psychology and primary care: Practical advice and clinical guidance for successful collaboration. Washington, DC: American Psychological Association.
- Gatchel, R. J., & Weisberg, J. N. (Eds.). (2000). Personality characteristics of patients with pain. Washington, DC: American Psychological Association
- Turk, D. C., & Gatchel, R. J. (Eds.). (2002). Psychological approaches to pain management (2nd ed.). New York: Guilford Press.
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