Welcome to the continuing series Why You Should See a Pain Management Psychiatrist.  Last week we learned that psychiatric symptoms – such as depression, anxiety, etc. – often accompany chronic pain.  This week we’ll look at how to treat psychiatric diseases.

As we saw, depression (8-50% of patients with pain), anxiety (19-50%), PTSD (10%), sleep disturbance (50% or more), drug and alcohol problems (3-19%) are common in patients with pain.  Let’s look at some important issues related to treating these problems.

1. Identifying symptoms

To be able to treat psychiatric symptoms, they first have to be identified.  Your doctor should be asking about these common symptoms and referring you if appropriate.  You should also report if you’re having such symptoms.  Don’t be embarrassed or feel like you’re complaining.  Getting help is important!

2. Taking symptoms seriously

If you’re having significant depression, anxiety or other symptoms, it’s important to report these to start to get treatment for them.  These symptoms should not be dismissed as, “of course you have depression – it’s because of your pain.”  Chronic pain does not automatically  mean depression, anxiety and disturbed sleep.  There’s treatment for these symptoms.!  And they should be treated!

3. Treat all the disorders that are present.

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

4. Treatment

There are both therapies and medications to treat nearly all psychiatric diseases.  Medication should be used only along with therapy.  I strongly recommend trying therapy first, before medication, to see if just therapy alone can work.  There are times, when psychiatric symptoms are severe, that both will be started at once, but that’s less common.  Most people with pain disorders are already on several medications and sometimes already tolerating side effects, so trying non-medication treatment first makes sense.

Other articles in the 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