A major change in the financial incentives for care of Psychophysiologic Disorders (PPD) has just occurred in the United States (1). The case for integrating both medical and mental health care into primary care has always been compelling. Now, in 2017, the U.S. Medicare/Medicaid system has decided it will pay for a form of care that is strongly aligned with this concept (more on that below).
Archive for the ‘Stress Research’ Category
A paper published in 2014 (1) is getting a lot of attention now because of the following conclusions (italics mine): (more…)
Prescription opiate medication for chronic pain is a treatment whose time is ending. To quote Dr. Tom Frieden, director of the Center for Disease Control (CDC), for most pain patients the benefits of opiate painkillers are “unproven and transient” and they can be “just as addictive as heroin.” In addition, annually since 1999, ten thousand people have died from overdoses of prescription painkillers. The pain management community has concluded that, apart from people with cancer pain or those at the end of life, opiate painkillers have become a public health crisis. The CDC now recommends against using them for most non-cancer patients.
Acceptance by the health care profession that Psychophysiologic Disorders (PPD) can be successfully diagnosed and treated will depend on completion of at least two randomized controlled trials (RCT). The RCT is the gold standard method for documenting that a new form of treatment is superior to a placebo. Only when a treatment passes this test and that passing is then confirmed by at least one additional RCT will clinicians consider making the effort to apply it to their patients.
Among physicians with a humanistic soul, perhaps no quotation is more fondly remembered than one from Dr Francis Peabody. He was born in 1881 to a prominent New England family, trained at Harvard and Massachusetts General Hospital and was the first director of the Thorndike Laboratory at Boston City Hospital. Tragically, he died of sarcoma at age 46.
A study of the brain (published on-line Jan 2015) has uncovered an important difference in the processing of pain signals between people with fibromyalgia (FM) and those without FM.(1) Participants with FM had brain imaging with functional magnetic resonance (fMRI) while a blood pressure cuff on their leg created pain at a level (determined by each person) of 40 out of 100.
The last post briefly described a few psychotherapy concepts employed by students of Carl Jung. I wrote this to suggest the diversity of the scores of theoretical models currently used to treat clients. Why are there so many? The answer seems to be that they are all about equally effective when compared in trials so none has become dominant. Why are they so similar in their outcomes? The best explanation is that the theory behind a particular psychotherapeutic approach is one of the least important of several factors that determine how much a client benefits from treatment. What are these other components? In order of importance they are factors connected to: (more…)
The question of the prevalence of Psychophysiologic Disorders (PPD) is an important one so I looked into it a little more. The original study of this issue was by Kroenke & Mangelsdorf in 1989 and found that 70% of primary care patients had no explanation for their symptoms 12 months after they first went to their primary care physician. However, this study was done on a military base and though it included non-military family may not have been representative of the general public.
There is a new compilation of the latest research on the long-term impact of childhood adversity. I have written about this key subject in earlier blogs (here and again here). Now there is a new DVD where the latest research and its implications for policy are presented by those who conducted the studies.
Keele University in Staffordshire, England is fifty years old and educates 10,000 undergraduates on a square mile of land once owned by the same family for four centuries and prior to that by the medieval Knights Templar. Their arthritis research unit has published an interesting paper comparing usual care of low back pain with a new approach based on stratifying patients into three groups (1).