Psychiatrists Have Tools Needed to Help Patients in Pain


David Copenhaver, M.D., M.P.H., the associate director for advancing pain relief at the University of California, Davis, was trained in anesthesiology and specializes in palliative care for cancer patients. Yet as began his presentation Saturday at this APA’s Annual Meeting, he assured the audience that he was much like them.

“I’m a pain specialist, yes, but this room is filled with pain specialists,” he said.

To expand on this connection, he showed a slide with the International Association for the Study of Pain’s definition of pain, which read, “An unpleasant sensory and emotional experience, associated with actual or potential tissue damage.”

As he continued his lecture, titled “Pain Medicine and Psychiatry: Mind, Mood, and Much More,” Copenhaver described how theories of how the brain processes pain have evolved over time—from early neuroimaging work suggesting specific brain regions are linked with pain (the “pain matrix”) to more current understanding of brain plasticity and how chronic pain can change brain connectivity over time.

While such knowledge has led to the notion that in some cases, pain may be a disease and not just a symptom, it has also made pain a more multidisciplinary topic of discussion, Copenhaver said. Today, physicians appreciate that chronic pain involves vicious cycles of both physical and psychological feedback. Copenhaver went on to describe the various therapeutic options available to treat pain, highlighting the various short- and long-acting opioids, as well as anti-inflammatory drugs, NMDA antagonists such as ketamine and memantine, antidepressants, and steroid therapy.

In particular, buprenorphine and oxytocin may offer benefits for patients with pain and other mental health challenges, he said. As a partial inhibitor of mu opioid receptors, buprenorphine can provide analgesia with less risk of tolerance and less side effects while also offering some mood improvement independent of pain relief. Oxytocin, which psychiatrists know as a social hormone that has potential as an anxiety medication, can also relieve trigeminal nerve-related pain (pain around the face and ears).

In contrast, he recommended against the use of benzodiazepines and cannabis for treating pain. The issue with the former, he said, is that “all the evidence suggests benzodiazepines have no use beyond the very short term,” while the federal government considers the latter agent to be a controlled substance with no medicinal value.

Medications aren’t the only options for pain management, Copenhaver said. Cognitive-behavioral therapy, coping strategies, mindfulness, relational frame theory, support groups, acupuncture, massage, physical therapy, and neuromodulators have all been shown to lead to improvements in patients in pain.

(Image: iStock/ Wavebreakmedia)