William S. Jacobs M.D. - Member, RiverMend Health Scientific Advisory Board for Addiction & Psychiatry Associate Professor University of Florida Dr. Jacobs addresses the RiverMend Health Scientific Advisory Board on levels of pain and how it leads to addiction. He discusses how to manage and asses the pain in ways other than drugs. For more information visit: http://www.rivermendhealth.com/scientific-advisory-board-addiction.html

1. UF Pain Care
Recognition & Response
to Complex Problems
William S. Jacobs, MD
Associate Professor
University of Florida

2. Pain
• Unpleasant sensory and emotional experience
associated with actual or potential tissue
damage or described in terms of such
• Subjective
• Painometer only exists in dreams & wishes…
• Multiple useful standardized scales and tests
but all measure only parts of the patient’s
problem

3. Acute Pain
• States that can be brief, lasting moments or
hours, or can be persistent, lasting weeks or
months until the disease or injury heals.
• Predictable beginning, middle and end

4. Chronic Pain
• Persistent pain
– either continuous or recurrent
– Sufficient duration & intensity to adversely affect
well-being, level of function & quality of life
– Not untreated acute pain
– Time frames continue to vary
• 6 months
• 3 months
• 6 weeks
• Or less

5. Chronic Pain Syndrome
• End of the spectrum of chronic pain
• Constellation of behaviors related to
persistent pain that represent significant life
role disruption

6. Addiction
• Primary, chronic, neurobiologic disease with
genetic, psychosocial & environmental factors
influencing development & manifestations.
• characterized by
– Impaired control over use
– Compulsive use
– Craving
– Continued use despite adverse consequences
– Relapses or failed attempts to cut down

7. Chronic Pain is complex
• another Biopsychosocial disorder
• No one-to-one relationship between organic pathology
and pain intensity
• Shaped by multiple factors
– Biomedical
– Behavioral
• Context
• Responses by significant others
– Psychosocial
• Patients’ and providers’
– Beliefs
– Expectations
– Moods

8. “Usual” Evaluation (not ours)
• Incorrect assumption/hope by both patients
and providers that some underlying
pathology is both necessary and sufficient
cause of the symptoms
• Attempts to identify the pain generator
– History
– Physical Exam
– Appropriate testing such as lab or imaging

9. “Usual” Evaluation…II
• In absence of identifiable underlying organic,
likely responsible pathology
– Many providers assume symptoms stem from
psychological factors
– Psychatric &/or Psychological evaluation
– Dichotomous view or Duality
• EitherEither somatic oror psychogenic
• Unusual not to have components of both

10. Chronic Pain affects more than just the individual
• Key Premise
– Multiple factors influence symptoms and functional
limitations of chronic pain patients
– UF Comprehensive Assessment
• Search for pain generator
• Patient’s specific
– psychosocial & behavioral situation
– Emotional state (depression, anxiety, frustration,anger)
– Perception & understanding of symptoms
• Significant others’ reactions to patient’s symptoms
• Evaluation for presence or potential for co-existing addiction

11. UF Treatment
• Treat the whole patient and all others
significantly involved in their lives
• Coordinate care with multiple specialists
• Continuously monitor, reassess and adjust
care; then repeat…
• Just opioids is not only not the answer, it’s
fueled the problem…
• Innovative state of the art Interventional
Procedures