Operationalizing Pain Treatment in the Biopsychosocial Model: Take a Daily "SWEM"--Socialize, Work, Exercise, Meditate.

In the United States, chronic pain is often poorly treated at an exceedingly high cost. The use of the biomedical model to manage pain is frequently ineffective, and evidence suggests that the biopsychosocial (BPS) model is a better choice. A problem with the BPS model is that it has not been operationalized in terms of patient behavior. This commentary addresses that issue by suggesting that people with chronic pain and illness participate daily in four self-management health behaviors: socialize, work, exercise, and meditation, and discusses evidence that supports these recommendations. These self-management behaviors may decrease pain and thus reduce the need for pain medications and other medical interventions. Additional topics include patient adherence and health coaching.

A 40-Minute Phone Intervention.

This article recounts the experience of an 88-year-old woman with sciatic pain and her attempts to get it treated. Common interventions were utilized and failed, and back surgery was recommended. A patient advocate was consulted who suggested the need to begin to exercise and to reconsider other medical interventions. Within 2 months, she was pain-free and returned to her active lifestyle. The use of scientific evidence and common sense prevented unnecessary surgery and other costly medical treatments.

Pain and treatment from a human primate perspective.

Human animals have evolved with the primary missions of survival and reproduction and these natural drives may impact behavior whether humans are aware of them or not. The author offers evidence in support of the idea that injury and resulting acute or chronic pain may trigger the unconscious human primate brain to believe there is a threat to survival. This perceived threat may be exacerbated or mitigated by the pain manager, both of which may impact health outcomes in a negative or positive way, respectively. The commentary argues the patient-health care provider relationship is of paramount importance for those with chronic pain and illness and should be nurtured for the best possible outcomes.

Simple maintenance for dramatic effect.

In an article which first appeared in print in the March 2012 issue of The Australian Hospital Engineer, based on a presentation given at the Institute of Hospital Engineering Australia's 2009 National Conference, Scott Wells, energy manager, Engineering & Building Services, at Royal Brisbane Women's Hospital, and Mark Collen, a district account manager, Engineering and Process Development Division, at water treatment specialist, Nalco, discuss how sound, regular, and thorough, maintenance and cleaning of hospital air-handing units will not only enhance their operating efficiency, but will also help reduce airborne infection risk in the healthcare facilities they serve. They also detail practical measures taken at hospitals in Queensland to reduce the energy consumption of air-handling equipment.

Profit-driven drug testing.

Random drug testing of people being treated for chronic pain has become more common. Physicians may drug test patients on opioid therapy as a result of concerns over prosecution, drug misuse, addiction, and overdose. However, profit motive has remained unexplored. This article suggests profits also drive physician drug-testing behavior and evidence is offered, including an exploration of Medicare reimbursement incentives and kickbacks for drug testing.

Prescribing cannabis for harm reduction.

Neuropathic pain affects between 5% and 10% of the US population and can be refractory to treatment. Opioids may be recommended as a second-line pharmacotherapy but have risks including overdose and death. Cannabis has been shown to be effective for treating nerve pain without the risk of fatal poisoning. The author suggests that physicians who treat neuropathic pain with opioids should evaluate their patients for a trial of cannabis and prescribe it when appropriate prior to using opioids. This harm reduction strategy may reduce the morbidity and mortality rates associated with prescription pain medications.

The Fourth Amendment and random drug testing of people with chronic pain.

It is common for physicians who prescribe opioids for chronic pain to drug test their patients. This practice may soon be mandated by the State of Washington as a result of passage of their new law ESHB 2876. Random drug testing of people simply because they seek treatment for chronic pain arguably constitutes a suspicionless and warrantless search that violates both the Fourth and Fourteenth Amendments. Issues discussed include consent, circumstantial coercion, and "special needs" searches.

Analysis of controlled substance agreements from private practice physicians.

Controlled substance management agreements (contracts) are widely used by pain specialists in the United States, but what do they contain? This survey analysis answers that question by taking a thorough look at 41 controlled substance medication management agreements from physicians in private practice.

Opioid contracts and random drug testing for people with chronic pain - think twice.

The use of opioid contracts, which often require patients to submit to random drug screens, have become widespread amongst physicians using opioids to treat chronic pain. The main purpose of the contract is to improve care through better adherence to opioid therapy but there is little evidence as to its efficacy. The author suggests the use of opioid contracts and random drug testing destroys patients' trust which impacts health outcomes, and that physicians' motivation for their use are concerns about prosecution, medication abuse and misuse, and addiction. Statistics are provided to counter fears, and evidence is offered suggesting opioid contracts are unenforceable and lack efficacy; random drug testing is often inconclusive, and a patient's trust improves adherence to treatment.