christopher t caldwell, d.o. medical director, montana spine and pain center
DESCRIPTION
The object of the physician is to find health . Anyone can find disease - A. T. Still , M.D., D.O. Christopher T Caldwell, D.O. Medical Director, Montana Spine and Pain Center Board-certified, Neuromusculoskeletal Medicine Boar-certified, Osteopathic Manipulative Medicine - PowerPoint PPT PresentationTRANSCRIPT
The object of the physician is to find health.
Anyone can find disease- A. T. Still, M.D., D.O.
Christopher T Caldwell, D.O.Medical Director, Montana Spine and Pain Center
Board-certified, Neuromusculoskeletal Medicine
Boar-certified, Osteopathic Manipulative Medicine
Fellowship-trained, Pain Medicine
Conflict of Interest Disclosure: Christopher T. Caldwell, D.O.
Has NO real or apparent conflicts of interest to report.
Pain is hard-wired to fear
• Fear of Damage– Your back is Shot– What a Train Wreck– Worst I’ve ever seen
• Fear of the Future– Lucky to Not be Paralyzed– You’ll end up In a
wheelchair
• Fear Sells – You’ll end up Needing
Surgery
Need to Compensate for patients’– Negative Attention Bias– Catastrophizing– Fear-avoidance– Low self-efficacy– False beliefs about pain
Stop Catastrophizing!!!
Inflammatory• Degenerative• Arthritis• Stenosis• Annual tear• Disc protrusion• Facet arthropathy• Bone spur• “Out of place”
“Translate” for the patient
Inflammatory• Degenerative• Arthritis• Stenosis• Annual tear• Disc protrusion• Facet arthropathy• Bone spur• “Out of place”
Reassuring = No Danger• Candles on your cake• Wear and tear change• Less breathing room• Normal wear• Gravity wins• “Knuckle joints”• Calcium inside a tendon• Stuck
Finding Health is about Language
• Radiologists aren’t talking to patients– Don’t read reports to patients
• You are talking to their limbic system
Case 1• MD, 56 yo female, changing insurance – establishing
with new pcp• 9 years of low back pain• 6 years of “total body” pain• Methadone 90 mg three times daily• hydrocodone/acetaminophen 5/325mg as needed – up to
6 tabs daily• Pain Diagnosis : chronic pain syndrome, fibromyalgia• Other Medical history: Type II diabetes, hyperlipidemia,
fatty liver disease, obesity, remote tobacco history, depression, insomnia
Case 1 – More History
• Immigrated from Cuba in 1997 where she was a lawyer – Spanish speaking only
• In US worked at Goodwill sorting clothes• Lived with alcoholic husband and 2 children
Husband left soon after arriving and currently only one child living with her
• Injured back at Goodwill in 1998 and some time after that was declared disabled
• Brought Mother over in 2002
Case 2
• BG 56 year old male• Active problem list
HIV+• Bacterial pneumonia , twice in last 5 years• Neuropathy – HIV?• lipodystrophy
COPD > 40 pack years of tobaccoHistory of poly-substance abuse, clean since age 42Orthostatic hypotensionHypogonadismDepression with anxiety and insomniaHepatitis CChronic lumbar pain with radiculopathy
• Arrives by wheelchair, flat affect, on oxygen• Doctor appointments are only time he leaves house
Challenging discussions
• Are you saying this is all in my head?• It’s really not safe for a person with a
condition like mine to do _____.• But I have something real going on, so all
of this doesn’t really apply to me.• I need to get my pain under control before
I can get back to_____.• But what are you going to do for my pain?