BL is a 76-year-old male patient who suffers from lower back pain that radiates into the lower extremities. He has had lumbar surgery; however, it was not successful. When BL was first accepted as a new patient, he was on high doses of hydromorphone. This was reported to be the only opioid agent that adequately controlled his pain.
Over the past year, BL lost his wife to Alzheimer’s disease, which was very traumatic for him. Shortly after his wife died, he became acquainted with another woman close to his age and subsequently began dating. Shortly after the relationship started, his new friend was diagnosed with terminal cancer. She, too, died shortly after the diagnosis was made.
BL suffered from significant depression during this period of time. He had not only lost his wife, he also lost someone he had become very fond of within the same year. Not surprisingly, his pain, which had been stable and well managed up until that time, began to exacerbate. Multiple opioid rotations and adjustments were made in attempt to better control his pain, but none of the changes were effective.
After his losses, BL would frequently come to his follow-up visits with new and multiple pain complaints, which were never bothersome to him previously. Consideration was being made for antidepressant treatment; however, unexpectedly, BL met yet another individual and started dating once again.
Fortunately, this time around, things have gone very well for him, and during his last appointment, he said he was feeling so much better than before. He reported he was falling in love again. His last pill count identified an overage, and he actually admitted to taking less of his pain medication since he was feeling so much better. He now desired to taper off other non-opioid medication to determine if indeed they were needed.
The correlation between mental health and how well chronic pain is controlled has been well established, and this particular case appears to demonstrate this relationship quite well. The only contributing factor to BL’s severe exacerbation of pain was related to his mood and the negative emotions he was experiencing at the time.
Have similar experiences been observed in your practice that demonstrate the significant impact emotional pain has on physical discomfort? Share your experience in the Comments section below. Dr Pacheco will be available to provide insight and feedback to your comments in this moderated forum.