Psychological analysis skills can lead to safer pain care

Primary care physicians may do well to learn how to screen patients for psychological disorders to lower the risk of improper drug prescriptions when treating pain symptoms, according to Robert McCarron, DO.

The screening process looks for anxiety, mood, psychotic, and substance use disorders (AMPS) that can be used by primary care physicians to determine the best way to treat a patient’s pain symptoms, explained Dr. McCarron, professor in the department of psychiatry at the University of California, Irvine, and president-elect of the California Psychiatric Association.

Nearly 60% of patients with chronic pain also have an affective disorder, with certain psychological disorders exacerbating or even causing physical pain, according to Dr. McCarron. Given that, the need for psychiatric evaluation tools and education in primary care is growing rapidly, especially because primary care physicians provide nearly 60% of all psychiatric care in the United States, he said at a meeting held by the American Pain Society and Global Academy for Medical Education.

“We know that 70% of psychiatrists are over the age of 50, and there also aren’t enough pain medicine doctors,” said Dr. McCarron. As of 2016, there are 4,627 mental health care professional shortage areas, with only 44.2% of those who need mental health care having their needs met, according to the Kaiser Family Foundation.

As primary care physicians shoulder that burden, a common complaint is not having enough time to build a relationship so patients will feel comfortable enough to talk openly about psychiatric symptoms, said Dr, McCarron.

“What I would say is make time for what is most effective,” said Dr. McCarron in an interview. “When it comes to psychiatric disorders and chronic pain management, setting aside some time during the visit to establish a relationship is critically important.”

To help primary care providers feel more comfortable in their ability to diagnose psychological disorders, Dr. McCarron and his colleagues are creating educational tools such as the AMPS assessment.

In addition, “one of the things we’ve done is create a Train New Trainers primary care psychiatry fellowship, where we train practicing primary care providers,” said Dr. McCarron. “We provide a 1-hour longitudinal training in this area, and at the end of that, they know how to diagnose effectively and treat in an evidence-based way, and they know how to train other people in their clinical site or region.”

On top of the fellowship, Dr. McCarron and his colleagues are working on a textbook covering relevant psychiatric material for primary care physicians.

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ezimmerman@frontlinemedcom.com

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