Robert J. Gatchel, Ph.D., ABPP
Nancy P. & John G. Penson Endowed Professor of y
gy
Clinical Health Psychology
Professor and Chair, Department of Psychology, College of Science, The University of Texas at Arlington
Director of Clinical Research, The Eugene McDermott Center for Pain Management, The University of Texas Southwestern Medical Center at Dallas
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y “I have no relationship that could be perceived as placing me in a real or apparent conflict of interest in the context of this presentation.”
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The Biomedical Reductionist Perspective versus the p
Biopsychosocial Model of Pain
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Biopsychosocial Model
Complex and Dynamic Interaction among Physiologic,
Psychologic and Social Factors,
Factors which Perpetuates and
May Worsen the Clinical Presentation
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Physical Limitations
Strain on
Coping
Resources
PAIN
Psychosocial
Sequelae
STRESS
Financial/Job Problems
Personality
Predispositions
Medical Uncertainty
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2
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Patient Heterogeneity and Response to Treatment
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Transition From Acute To Chronic Pain
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Physical Deconditioning
Physical Deconditioning
Mental Deconditioning
Pain
Stage 1
(Hurt=Harm)
Initial Psychological
Pain
(Hurt=Harm)
2
Stage 3
MentalStage
Deconditioning
Development or Exacerbation Acceptance of “Sick
StageDistress
1
Stage
2
StageRole”
3 and
(Fear,
of Psychological Problems*
Initial
Psychological
Development
or Exacerbation of
Acceptance
of “Sick Role”
Anxiety, Worry,
ƒ Learned HelplessnessConsolidation of
Distress (Fear, Anxiety, Psychological
Problems*
and Consolidation
of
Etc.)
DepressionAbnormal
Illness
Worry, Etc.)
ƒ Demoralization
Learned HelplessnessAbnormal Illness
Behavior
Depression-Demoralization
Behavior
ƒ Anxiety
DisordersS
M
Magnification
ti
ƒ Symptom
An iet tDisorders-Symptom
Anxiety
Disorders
Sifimptom
ƒ Psychophysiological
Magnification
ƒ Disorders
Psychophysiological Disorders
ƒ Personality Disorders
ƒ Personality Disorders
ƒ Anger-Distrust and
ƒ Anger-Distrust and Entitlement
Entitlement
ƒ Substance Abuse
ƒ Substance Abuse
Form Depends
on Premorbid
Personality/Psychological
ƒƒ Form
Depends
on Premorbid
Characteristics, As Well As CurrentCharacteristics,
Socioeconomic Conditions
Personality/Psychological
As
Well As Current Socioeconomic Conditions
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Disease Versus Illness
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BIOPSYCHOSOCIAL MODEL FOCUSES ON ILLNESS
y The interrelationships among biological changes, psychological status, and the sociocultural context all need to be considered
y This helps to explain the diversity of pain or illness expression, including its severity, duration and psychosocial consequences.
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Biopsychosocial, Interdisciplinary Treatment
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Treatment‐ and Cost‐ Effectiveness
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Functional Restoration as an Example
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Functional Restoration (Cont)
y Psychosocial and socioeconomic assessment to guide, individualize, and monitor cognitive‐behavioral oriented interventions and outcomes
y Multimodal disability management program using cognitive‐behavioral interventions
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Functional Restoration (Cont)
y Formal, repeated quantification of physical deficits to guide, individualize, and monitor physical training
y Physical reconditioning of the injured functional unit
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Functional Restoration (Cont)
y Generic work simulation and whole‐body retraining
y Psychopharmacological interventions for detoxification and psychosocial management
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Functional Restoration (Cont)
y Interdisciplinary, medically directed team approach with formal staffings, frequent team conferences, and low staff‐to‐patient ratios
y Ongoing outcome evaluation, using standardized objective criteria
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Early Intervention for LBP
y Developed algorithm for identifying acute, low back pain patients at risk for developing chronicity (Gatchel, Polatin & Mayer, 1995)
y Early intervention for high‐risk acute low back pain Early intervention for high risk acute low back pain patients (Gatchel et al., 2003)
y Combine early intervention with work‐transition component
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Early Intervention for TMD
y Developed algorithm for identifying acute TMD patients at risk for developing chronicity (Epker, Gatchel & Ellis, 1999)
y Early intervention for high‐risk acute TMD patients Early intervention for high risk acute TMD patients (Gatchel et al., 2006; Stowell et al., 2007)
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References
y Gatchel, R.J., Clinical Essentials of Pain Management, Washington, D.C.: American Psychological Association, 2005
y Gatchel, R.J., Okifuji, A. Evidence‐Based Scientific Data for Documenting the Treatment‐ and Cost‐
Effectiveness of Comprehensive Pain Programs for Chronic Nonmalignant Pain. Journal of Pain, 7(11): 779‐793, 2006
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y Gatchel, R.J., Polatin, P.B., & Mayer, T.G. The Dominant Role of Psychosocial Risk Factors in the Development of Chronic Low Back Pain Disability. Spine, 1995, 20, 2702
Spine 1995 20 2702‐2709
2709.
y Gatchel, R.J., Polatin, P.B., Noe, C., Gardea, M., Pulliam, C. & Thompson, J. Treatment‐ and Cost‐
Effectiveness of Early Intervention for Acute Low Back Pain Patients: A One‐Year Prospective Study. Journal of Occupational Rehabilitation, 2003, 13: 1‐9.
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y Epker, J., Gatchel, R.J. & Ellis, E. An Accurate Model for Predicting TMD Chronicity: Practical Applications in Clinical Settings. Journal of the American Dental Association, 1999, 130, 1470‐1475.
y Gatchel, RJ., Stowell, A.W., Wildenstein, L., Riggs, R. & Ellis, E. Efficacy of an Early Intervention for Patients with Acute Temporomandibular Disorder‐
P i
i h A
T
dib l Di d
related Pain. Journal of the American Dental Association, 137: 339‐347, 2006.
‐‐Winner of the International Association for Dental Research’s 2006 Giddon Award for Outstanding Temporomandibular Joint Disorder Clinical Research.
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y Stowell, A.W., Gatchel, R.J., Wildenstein, L. Cost Analysis of Temporomandibular Disorders: Biopsychosocial Intervention versus Treatment as Usual. Journal of the American Dental Association, Usual Journal of the American Dental Association 138: 202‐208, 2007.
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