Anesthesiology

Addiction/Psych Rotation

Goals:

To appreciate the impact of psychiatric dysfunction in the experience and management of pain
To appreciate the scope and impact of psychological addiction in patients with chronic pain
To appreciate the critical nature of psychiatrists and psychologists in the multidisciplinary management of chronic pain
To foster collaborative institutional treatment of complex patients with pain and psychological comorbidity

Objectives:

To perform complete psychiatric history with special attention to psychiatric and pain comorbidities, including completion of a mental status exam on a minimum of 15 patients, five of which must be in the presence of a faculty observer, ACGME IV.A.5.1.d
To interview and examine patients with common psychiatric and pain co-morbidities, including substance-related, mood, anxiety, somatoform, factitious, and personality disorders, ACGME IV.A.5.1.d.
To demonstrate understanding of the principles and techniques of the psychosocial therapies, with special attention to supportive and cognitive behavioral therapies, sufficient to explain to a patient and make a referral when indicated, ACGME IV.A.5.1.d
To communicate effectively and professionally with referring providers
To formulate pain treatment plans which include, as appropriate: Medications, interventions, therapies, and appropriate cognitive behavioral therapy and coping skills training
To learn techniques for inpatient detoxification from opioids and benzodiazepines, including associated risks and benefits of each technique
To recognize signs of primary psychiatric disorder (including personality disorders), and methods used to distinguish these from a primary pain disorder
To gain understanding of institutional and community resources available for treatment of chronic pain patients with psychological impairment, addiction, and primary psychiatric disorder
To treat patients with respect and dignity
To take time to educate patients, regarding contributing factors and treatment options related to pain
To empower patients to participate in medical decision-making and to take responsibility for their role in the treatment plan
To recognize psychological, social, and economic issues which may affect patients and their families, and necessitate adjustment in management plan to accommodate these
To encourage patients to reconsider a “successful” outcome as increased functionality rather than decreased pain score