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Welcome to the continuing series Why You Should See a Pain Management Psychiatrist.  This week we’ll look at what a psychiatric evaluation includes.

When I see someone for psychiatric pain management, I initially do a psychiatric evaluation which includes these areas:

1.  Prior psychiatric functioning and psychiatric diagnoses

This lets me understand if someone has had difficulty with anxiety, depression, sleep, etc, even before confronting a pain disorder.  They may be at higher risk for these symptoms to recur.

2.  Current psychiatric symptoms

Unfortunately, psychiatric disorders often accompany pain.  Let’s look at some of the data:

• Depression…  8-50% of patients with pain
• Anxiety…  19-50%
• PTSD…  10%
• Sleep disturbance…  50% or more
• Drug and alcohol problems…  3-19%

We know that if multiple disorders are present, it’s crucial to treat them all.  For example, if someone has depression and pain, treating just 1 doesn’t necessarily mean the other will go away.  And sometimes neither gets better unless you treat both.

3.  Psychiatric interactions with medications

Many drugs used for pain cause psychiatric symptoms, including sedation or depression.  It’s important for someone on your treatment team to figure out what’s causing what and make recommendations to minimize side effects.

Some pain medications cause unusual or serious side effects.  For example, medications which are “NMDA receptor antagonists” such as Dextromethorophan or Ketamine can cause significant anxiety, hallucinations, or cognitive problems.  Most doctors using these require a prior psychiatric evaluation to be sure there aren’t underlying psychiatric disorders which might be uncovered by these medications.

4.  Treatment of psychiatric disorders

If psychiatric symptoms or disorders are found, treatment is crucial.  Having an expert in this area is important.  Treatment might include therapy, medication or both.

It’s also helpful to know that a good pain management psychiatrist will know how to treat issues related to pain.  Your treatment shouldn’t be just talking about how bad things are.  It also shouldn’t be treating a medical pain disorder as if it’s psychiatric.

Other articles in this series:

1. Why comprehensive treatment works better
2. Benefits of a psychiatric evaluation
3. Treatment of psychiatric symptoms
4. Using psychiatric medications for pain
5. Learning psychological skills
6. Making positive behavioral changes
7. Making positive psychological changes
8. Benefits of supportive therapy
9. Benefits of a pain support group
10. New brain-based treatments