Lesson Learned (June 18)


The bio-psycho-social-spiritual model of pain explains much about why we have such a persistent opioid epidemic here in Upshur County and throughout the central Appalachians. My Lesson Learned this week is that we must attend to all four components if we ever expect our Upshur County Schools students to live in a society that is not in a terrifying death spiral.

Physicians like myself take a yearly required refresher course on pain management in order to maintain an active West Virginia license to practice medicine in the Mountain State. Certainly, I endorse the concept of education. At the beginning of each Upshur County Board of Education public meeting, we remind ourselves of our Mission which in part is to become “lifelong learners”!

 Pain plays a signaling role in staying healthy. We teach children not to touch a hot stove to avoid getting burned. We say, “Once burned, twice cautious.” Biologically pain lets us maintain homeostasis.

Pain plays a psychological role. Folks who are depressed or anxious experience more severe pain suffering. Opioids give such persons “incredible euphoria,” which can add to their addictive nature.

Pain plays a social balancing role. If an older person can increase their self care or house/garden functions by getting pain relief, that is good. But they must avoid the dark side of addiction, such as allowing family members to use their prescription medication.

Pain plays a spiritual role. We coach in exercise and sports the idea of “no pain, no gain!” We use an understanding of “a higher power” in our 12-step recovery programs, allowing persons addicted to follow a clear path to become overcomers.

Spring (counter-intuitive to my view of our glorious natural rebirth of the flowers and trees here in the mountains) traditionally has the highest numbers of suicide. For this reason, May is designated as Mental Health Awareness Month each year.

One of the effective ways to take an inventory of mental health and recognize warning signs of distress that I have recommended to my patients is the PHQ-9 Depression Assessment. A score is given to each of 9 questions, based on how often during the past two weeks the person has been bothered by the following:

(Not at all=0; Several days=1; More than half the days=2; Nearly every day=3)

1 - Little interest or pleasure in doing things?

2 - Feeling down, depressed, or hopeless?

3 - Trouble falling or staying asleep, or sleeping too much?

4 - Feeling tired or having little energy?

5 - Poor appetite or overeating?

6 - Feeling bad about yourself — or that you are a failure or have let yourself or your family down?

7 - Trouble concentrating on things, such as reading the newspaper or watching television?

8 - Moving or speaking so slowly that other people could have noticed? Or so fidgety or restless that you have been moving a lot more than usual?

9 - Thoughts that you would be better off dead, or thoughts of hurting yourself in some way?

Add up the 9 scores for a total. The interpretation criteria for depression severity is:

0-4 none; 5-9 mild; 10-14 moderate; 15-19 moderately severe; 20-27 severe.

The basics are what we need to focus on in this uncharted time of the Coronavirus Pandemic. That is my Lesson Learned this week. The bio-psycho-social-spiritual model frames the self-examination quite well in my estimate.

 

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