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Psychometric testing to determine pain treatment


Barbarannamated
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Please relocate this if appropriate.

 

Just asked husband (an MD) why psychometric testing is used in pain treatment.

HIM: because if there's a personality disorder or personality traits, the person wont respond to treatment. If someone tests positive on MMPI for somatoform or conversion disorder, they won't respond to opiates.

ME: so how are they treated?

HIM: there is no drug treatment for personality disorders

ME: how do you treat the pain?

HIM: CBT may help

ME: do you think my MMPI showed a personality disorder?

HIM: I dont know. What did your treating psychologist say?

ME: he would never tell me the results, remember??

HIM: oh Dr. F*** never includes test results with his evals.

ME: so a persons chronic pain treatment is based on a 1 day psych test??

HIM: the MMPI has been shown to be very reliable. A V- conversion is hard to argue. Their pain comes from the psych disorder.

ME: and you trust psychiatry after everything I've been through and all you know now??

 

I had to leave room. My pulse is still racing. I've never been hit physically, but this feels like torture of some sort.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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Information about psychometric testing in chronic pain:

http://www.reedpetersen.com/portfolio/pe/pa/bridginggap/bridgefall2000.htm

 

Last question I asked, admittedly with a bit of attitude:

"There IS a complete medical/neuroendocrine workup done prior to diagnosing a personality/somatoform/conversion disorder that determines patient will forever be unresponsive to pharmacologic pain treatment, RIGHT?"

HIM: "No"

 

To clarify my thinking:

 

Person presents to pain specialist with chronic pain, in these cases due to injury. In some cases, patient does brief psychological test on handheld computer in waiting room BEFORE EVER SEEING DOCTOR. When I was at the worst point of my pain in 1990s (Work Comp injury), I tried to see a specialist at Cedars-Sinai in Los Angeles. He has a comprehensive pain clinic, which I believe is a good approach. However, I COULD NOT SEE HIM UNTIL I HAD A PSYCH EVAL BY HIS PSYCHOLOGIST which the Work Comp insurance would not authorize. I now think that may have been a good thing. I believe I ended up paying out of pocket to see him.

 

I am not arguing that there is a significant psychological component to pain. However, I am adamantly opposed to any treatment that attributes the pain to the psych disorder and incorporates psych profiling to guide or determine treatment. Psychological support is critical to deal with the distress and other sequelae of chronic pain or loss of function/career/income due to pain or injury. However, to administer psychological testing to someone in chronic pain who has likely been to at least a few doctors already and use those results to determine if pain is a SYMPTOM of psych/personality disorder or coping mechanism is unconscionable.

 

RE: no drug treatment for personality disorders - perhaps a fortunate point if it reduces tendency to prescribe psychotropics. I believe, however, that psychiatrists ARE using pharmacologic therapy.

 

Psych profiling is guiding medical treatment. Very disturbing. Not surprising that people are seeking pain treatment in the streets or on internet. And this doesn't even touch on the fact that SNRIs (Cymbalta, Effexor, Pristiq) are being used to treat pain and referred to as "pain drugs".

 

This is just one reason I find the DSM to be harmful.

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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you asked for my response on this post Barbara:

 

I'm not sure how often these sorts of tests are used in pain clinics...pain clinics, at least the ones I've encountered, are quite astute about the weird sorts of pain we have being neurological it's their bread and butter (neuropathies and parasthesias etc)...they don't know how to treat them, perhaps...since they end up often using drugs that made us all sick!! but the pain doctors I've talked to have been the only MDs that take my condition seriously and believe me...I was pleasantly surprised by that when I pursued the stellate ganglion block...

 

that being said, there may be other sorts of pain doctors out there that use that sort of testing, but given I interacted with several who all actually believed me it's not my experience. Cedar-Sinai, of course is a big hospital that likely does stuff that is considered "state of the art"

 

So it's clear this testing is being used some but I don't think it's broadly used yet...and there are plenty of docs that don't take psychiatry seriously as well...lets hope it doesn't catch on broadly!!

 

anyway, it sucks, yes.

Everything Matters: Beyond Meds 

https://beyondmeds.com/

withdrawn from a cocktail of 6 psychiatric drugs that included every class of psych drug.
 

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Thanks, Gia. I'm glad you've had good experiences with pain management docs. I generally have, also. It's what I've heard at home office that is most disturbing since realizing the fraud of psychiatry, overdiagnosis, etc. May also be more prevalent in Occupational Medicine and Interventional Pain Clinics (anesthesia and PM&R).

 

Thanks again, Gia. My 'reactivity' definitely went off the charts on this last nite.

 

B

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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