and good evening.

>> Thank you so much for watching HealthLine here on PBS Fort Wayne.

>> I'm your host tonight.

A very important topic especially with the pandemic we're going to talk about pain and mental health and just through some of the research and preliminary things I've been reading about this program will do tonight, it's going to be very interesting and we're going to open up those phone lines at 866- (969) to seven to zero for you to call to address your concerns and answer your questions and doesn't have to be for yourself if someone you love, someone you know please call and our special guest tonight we have Dr. Renee Buskirk and this is the first time for you on that is it's my first time.

Yeah, well you kind you're more than welcome to be here and we thank you very much for taking the time.

I know that you have a busy schedule and Dr. Brian Hutner you've been on the show before with me in fact a couple of years.

Yeah.

And the phones were really lighting up and we were just feeling we were getting started and then the show had to end.

So we're going to kind of pick up on some of the facets of that show tonight and talk about pain and mental health and the phone number of course is on the screen for you to give us a call any time during the show and we appreciate that.

So let's go and get started.

By the way, your clinical psychologist, both of you and what is the correlation between chronic pain and mental health ?

>> Well, there there's a really a bidirectional relationship between pain and mental health in particular depression and anxiety.

So basically when one of those goes up that you see increases in the other one and vice versa.

So we see people with depression or anxiety or both and then when that increases we often will see their chronic pain also go up.

And if people are experiencing chronic pain, for example, we also will see them get more depressed, more anxious, more frustrated, angry.

So there's there's that relationship where they go back and forth and depression overall can actually cause some physical problems.

>> Is that correct?

Definitely.

Definitely depression and anxiety can cause physical problems.

There's some research that's been recently published that says about 70 percent of pain patients have clinical symptoms of depression and anxiety.

>> So that's a significant number of our pain patients that have mental health attributes that we need to address.

And if we just do that through pain management, we are not treating the whole individual.

And it seems like it could be linked together.

I think a lot of people don't realize that.

And what is chronic pain versus acute pain?

Chronic pain is when pain occurs for more than three months at a time.

OK, acute pain might be something that happens after an immediate injury chronic pain continues oftentimes for a lifetime for an individual.

>> A lot of times a lot of our patients with chronic pain, they've experienced an injury and it might get better but they are dealing with elements of that pain for much of their life if not all of their life .

So chronic pain is a very stable part of somebody's life and it becomes very controlling over our life changing functional goals, changing their goals and what they want to do in their life , their jobs, their relationships.

So it becomes a very pertinent aspect functioning well in today's world.

>> How many people are affected and what is the most affected age group?

Well, most recent research that that I've run across is about 50 million people in the United States and about 20 percent although there are estimates that go up to 40 percent of people at some point experience chronic pain.

So it affects a huge portion of our population and given those statistics, those numbers every one of us knows somebody probably personally and closely in family or close friendship who is dealing with chronic pain on a regular basis.

>> So it's very prevalent in other people who have chronic pain but just decided to deal with it and live with it and and won't seek help.

>> Are you seeing that in your practices?

We don't necessarily see those people in our practice because they are not coming.

>> Yes.

Well, I think there are a lot of people that have that type of difficulty.

They have chronic pain but they choose to avoid it.

They try to do things such as yoga apply to other things in order to stay physically active.

But eventually the chronic pain or the pain situation is going to catch up with them and they're going to feel discomfort and or numbness or some type of physical symptom if they're going to seek assistance for and it could get worse.

>> Yes.

Yeah.

And just to jump in on there to answer the rest of your question.

She said what age group is maybe more affected?

First of all, the gender there's a little disparity there.

Women are a little more likely than men to suffer from chronic pain or at least be diagnosed treated for it.

And then also age group we generally see a little bit older people, you know, 40s, 50s and up although it's not unheard of for younger people.

>> And why does it lean more toward women or do they know yet?

I'm not sure that there's an easy answer for that in part it probably has to do with what we're talking about tonight is that relationship between emotional and physical kinds of pain and how those correlate and women in general have a little bit different emotional kind of responses to things.

>> So so there's probably some correlation there.

>> I got a question earlier today one of our viewers would like to know and I'm sure some of our viewers don't know the difference but what is the difference between a psychologist and a psychiatrist ?

A psychologist is educated either with a Ph.D. or a side specifically to practice psychology psychiatrist is a subsidy or a medical degree that specializes in psychiatric care.

So neither Dr. Buskirk or myself have medical degrees but we have doctorates in clinical psychology.

>> And the reason why I'm asking is because you do obviously you take care of people's chronic pain and so forth and explain exactly what a pain psychologist is and does .

Well, a pain psychologist is generally a clinical psychologist who has some additional training or experience in dealing with pain specifically and what we do as part of usually hopefully a multidisciplinary pain treatment team is contribute to the team with regard to the emotional aspect of pain.

Also doing some assessments and screener's to identify what the psychosocial factors might be that are affecting the person's chronic pain experience and then not only doing that assessment piece with collecting information and informing perhaps the prescribers who are who may be considering prescribing opioids or some other form of medication to treat pain or trying to do decide whether to do interventional kinds of treatments like injections or something.

We kind of inform them to to to guide their decision making about the best course of treatment.

But then we also have our own set of treatments that we that we do including things like cognitive behavioral therapy treating you know, we can speak more about the details of that but but we do both the assessment and as well as the interventional kinds of and from the psychosocial and emotional perspective.

Well as pain psychologists do you also work with the family physician or maybe a psychiatrist that might be involved as well?

Oftentimes in our current practice we work primarily with for medical doctors practicing and nothing but chronic pain.

However, one thing that we see more and more is that there's a potential for risk in treating people that might have different mental health diagnoses or mental health histories when they come in for pain treatment.

So we need to be very vigilant at times and trying to evaluate some of the patients that come in if they have a substance abuse substance abuse disorder and we don't evaluate that don't notify the providing provider that they have that type of disorder, we could be setting them up for failure.

The patient could be set up for failure if they have to significant depression and we're not evaluating that and we're not allowing the physician to understand that the dynamics that depression that patient might also be set up for failure with different types of treatment plans most notably with anxiety.

Anxiety seems to be something that goes hand in hand with chronic pain.

The higher the anxiety level with our chronic pain patients, the less likely it is going to be that they're going to have benefit from some of the treatments that medical providers provide for treatment of chronic pain.

So if we provide providers some information about the psychological makeup of our patients, they can better treat them in understanding how to treat the patients in a safe and effective way.

So it's not about trying prevent treatment from the patient, it's about enhancing the treatments for the patients.

>> So communication is definitely a key.

Their so important I can see that.

And why should pain psychology be a part of treating chronic pain and you've kind of brushed over that before but it seems so important you have to know the person right and what makes them tick.

>> Absolutely.

In order to come up with an individualized treatment plan, it's important to consider the whole the whole person basically and it used to be many, many years ago that that chronic pain was treated via like a biomedical model which means that is kind of solely focused on that physical interventional medical kinds of intervention without consideration of the bio psychosocial kinds of factors that contribute to a patient's overall way.

They experience pain.

And so by adding that piece that that model that has emerged that includes the biopsychosocial piece, it's important that we're included as part of that team because we can address that help address that piece of it in order to hopefully optimize the patient's quality of life and their outcomes.

>> Then with that information you might be able to anticipate some further problems down the road and might be able to prevent those.

When you say yeah, let's talk about the opioids as you mentioned earlier.

Are we.

How are we faring with that right now?

I know that was a huge problem.

Are we getting is it and they still being overly prescribed or are they still are there are there important uses of opioids?

>> There are definitely important uses of opioids and that's from my perspective as a clinical psychologist, not a medical practitioner.

However, back in 2013 the state of Indiana gave us some guidelines and gave physicians guidelines on how they had to practice chronic pain management so they requested that clinical psychology be part of evaluating pain patients in order to do a benefit for the patient not to overly use medication.

>> So part of that law from 2013 is that a mental health evaluation using validated tools should be conducted with pain patients and also a substance abuse assessment should also be conducted.

So those are two valuable components to help prevent negative outcomes with the patient.

OK, very good.

Now we do have a call here coming in.

Let's see.

Yes, it looks like Tim has a question on line two .

>> Tim, go ahead and address your question to Dr. Hutner, please.

There you go.

Oh yes.

Well, I have a friend he's 40 years old six five two hundred forty pounds.

He worked doing tree trimming for a company he got her anyway.

>> He had to do some type of pain management because I had to drive him a couple times to this fancy office to get a couple big needles rammed into his back somewhere because he couldn't drive after his shot.

So I'm really concerned about pain management and now he's on heroin so he's got to go buy heroin somewhere and psychologically somewhat schizoid because he's been doing heroin for three or four I don't know years there's anyway sir ma'am, the drug addiction is obviously these opioids have heroin and heroin base.

But my question is about marijuana.

We now know that marijuana is one of our systems.

We have I'm sorry receptors marijuana receptors in our body.

I don't know why but you everyone knows now that marijuana is being used for pain.

Can you comment on marijuana relieving pain?

>> I never tried it but I'm just really curious.

Yes, I can comment about that in the state of Indiana with our current laws use of marijuana Campi use for chronic pain management.

However, there are there are a number of institutions in the United States that are doing research.

University of Michigan right now is doing a lot of research on the use of cannabis for pain control and what they're finding is there's a negative potential of using both cannabis and narcotics at the same time using marijuana can cause respiratory depression, can reduce somebody's level of oxygen intake, can relax but can also reduce chronic pain from what they're finding.

But when you combine that with maybe alcohol or narcotic medication, it can create adverse situations for the patient.

So those are things at least in a lot of the practices that we work with in Indiana.

If you're using marijuana, you're not going to be a candidate for some types of treatment or chronic pain.

>> You might be a good candidate for interventions with chronic pain but you're not going to be a candidate for early narcotics or narcotic medication typically.

>> I see and there are other classes of pain medication that are used besides narcotics and some people aren't aren't, you know, cognizant of that.

But there are other options that physicians do have within their toolkit to prescribe if if narcotics really are kind of ruled out because of marijuana or something else that's contraindicated and so.

>> All right.

Very good.

We have another call coming in effect on line five now Wesley prefers to be off the air and that's perfectly fine.

So I read the question his love for us when people have acute pain.

We talked about that earlier.

Can they get upset easier?

>> Do you have any idea what that might mean?

Individuals to have any type pain are much more likely to express themselves through anger, irritability.

They're going to show more signs of depression.

They're going to show frustration with family members.

>> And one of the things that we try to do as psychologists we try to work with the whole system.

There are times where we bring the families in for treatment.

There are times that we bring the patient in for coping skills training, our reduction in stress training, cognitive behavioral therapy to help reduce some of that irritability, the frustration it's not uncommon for most if not all pain patients to have a level variability in our practice.

The patients that we see we see a significant amount of frustration, anger, irritability, depression, a lot of mental health symptoms you might not qualify for a mental health disorder but they have the symptoms of the disorder and if they aren't treated appropriately those can then emerge into a disorder that can be diagnosed and pain can be a terrible thing.

The people who have pain they need to seek help.

So speaking of which, when someone has pain and they've been diagnosed with chronic pain and they need to to see a clinical psychologist what happens during a pain psychology visit?

>> OK, well during the initial visit it's it's really kind of twofold the patient will be asked really to fill out a couple of screening forms like I talked about earlier and what we're looking at there is kind of to to identify maybe some personality factors that might be relevant.

We might look at things like mood, you know, depression, tendency, the tendencies, anxiety tendencies, anger, hostility, that kind of thing.

But then we also look at what we call pain catastrophizing and we don't really like to use that term because it has kind of a negative connotation to it.

But what it is is people with who have a tendency to kind of exaggerate or magnify some of their symptoms like it's kind of a it's a negative form of thinking and when we think negatively that can make our pain feel worse positive there is power and positive thinking.

That's kind of a cliche but it is true research does hold that up.

So what we try to do is look at you know, how how do how have people developed thought patterns that might be negative and not helpful in their chronic pain experience as part of the screening tools and then the other part of it besides those screenings that we use is also a clinical interview which is very extensive where we collect a lot of information about things like like Dr. Hutner said substance abuse history, mental health history both for themselves, the patient themselves and their family members.

We talk about medications that they might have taken in the past, what their responses have been.

We talk about just general family dynamics, any kind of psychosocial kinds of stressors that might be impacting their their pain experience and then we use that to kind of try to come up with some suggestions and recommendations both to inform their prescribing provider as to what kinds of decisions they might need to make and do a risk benefit analysis of what what a treatments might be appropriate.

But then also we make recommendations from our own perspective.

What can we contribute to to the treatment in terms of addressing any depression, anxiety and those kinds of things by either treating just the patient or bringing in their family members?

>> OK, and I was reading up on this earlier pain disability scale.

Do you use that?

Yes, typically we use a pain disability scale so we have the patients describe how pain is interfering with a lot of different variables of their life such as whether or not they're able to do social activity, whether or not they're able to do chores around the house, whether or not they're able to have recreational activities and enjoy those, whether or not they can dress themselves in the morning, whether or not they can sleep at night.

So all these variables are added up and we come up with a score about how great pain is impacting their functioning in their life .

The whole purpose of chronic pain management is to create functional improvement in somebody's life .

So if your goal in life is to go bowling or go boating or to watch your grandkids play, we want to be able to help you get to those goals.

So if you have pain disability that can prevent you from getting there.

>> So if we manage and we track how pain is impacting different areas of your life , we can then start to specifically treat those areas of your life .

>> OK, that makes a lot of sense and then let's move on to the the other facets of pain control what a person need to be evaluated by a psychologist if they need an implantable neurostimulator or what they call a intrathecal pain pump pain pumps.

>> Is that necessary to see a clinical psychologist for this?

Yeah, and I'll give you a little bit of the history behind that.

A couple of decades ago a psychologist from southern part of the United States came up with a study where he evaluated patients and tried to determine whether or not there is any benefit to doing a psychological consultation with patients that are going to receive surgical procedures for chronic pain.

And the insurance companies jumped on top of that because they realized that if they could reduce based upon what the psychologist said to the agreement to provide a treatment they could save some money.

>> But what the hidden meaning what really happened with that was pain providers figured out that there were some elements of what psychologists could do to help predict who might do well with the procedures so insurance companies might have decided we might be able to save a dollar but the pain providers decided we can help determine who might be a better success story with the pain device who might not do well with one in pain, anxiety, pain, catastrophizing something that Dr. Buskirk talked about a little bit ago.

It's one of those topics that really goes hand in hand and correlates well with somebody who's not going to do well with implantable device for pain control.

If you are fearing an intervention you're setting yourself up for failure.

So there are things that a psychologist can do to help reduce some of the symptoms of anxiety and stress associated with going through an intervention to make you a better candidate and have a better outcome when somebody has a high level of anxiety you might sit tight, you might fight what you're trying to do with the intervention so you might hold your muscles tight.

>> You're tying yourself out, you might stiff, you might be afraid to move.

>> And so if we do something through a surgical procedure to help you reduce pain, you're still going to be experiencing pain because you haven't learned to allow that device to work effectively.

I see and how has chronic pain affected the suicide rate?

>> Is there a correlation there ?

>> There's been some recent research that has come out that has said that people who are depressed and have chronic pain, they're more likely to to end up as suicidal.

So there's a really big correlation.

We always have to watch people who who monitor very closely and supervise closely their pain treatment if they have chronic pain and major depression just because it does increase and enhance their chances of suicidality.

And it's super important that all pain providers address suicidality in their patients.

When you have somebody that's receiving a narcotic treatment that's a depressant.

If you have somebody who is already depressed because they're unable to function, unable to do things that they used to be able to do their finances are going downhill because they can't work.

That increases potential for suicide so painstakingly just is somewhat focused on addressing whether or not there's a history of suicidal ideation asking repeatedly during interviews about potential for suicide coping skills to deal with some stressors and making sure that the patients are safe with different types of treatment.

OK, I'm glad you addressed that.

Thank you.

And then I want to talk about before the show ends we've only got a couple of minutes I'm being signaled here but how has the pandemic affected people with chronic pain?

It certainly has had an effect .

>> It has had an effect.

What was interesting last year throughout the course of of of the pandemic experience in our practice was we were anticipating in some ways that just like the general population who don't experience chronic pain that we would see an increase in anxiety depression because of the stressors associated with, you know, being socially isolated and and just not being able to to get out and do things and that kind of thing.

But as things kind of emerge, we sort of thought, you know what what we're what we're finding out on on these phone calls and teller visits and so forth was that many of our chronic pain patients were almost more comfortable than the general population in part because that's kind of their norm.

Many of our chronic pain patients don't get out much, don't socialize much, tend to be more, you know, isolated to their homes.

So it wasn't the pandemic wasn't all that different in many ways for them.

So so yes, overall did increase anxiety, depression and so forth.

But as a segment of our chronic population actually I think kind of blended in as like the norm that they were almost used to.

>> Yeah, I heard a number of times you know, I feel like a lot of people are seeing what I've been living with the isolation, the fatigue, the depression and they weren't necessarily happy that other people were seeing it but they're pleased that people were able to experience something that they had experience to be able to put a attribute to it to say, you know, this is not good.

There's something that needs to be addressed that they can relate to.

>> Right.

Right.

All right.

Well, we're running out of time but really quick we got less than 30 seconds some resources available if you have chronic pain.

>> Well, do you want to take that?

Well, with with chronic pain going to your primary care physician asking for assistance, being willing to share with your primary care physician that you have difficulties with pain and then asking for resources from the primary care physician you have to make a referral.

You need to start with primary care physician.

I've been hearing that a lot in our conversation.

Very good.

Well, Dr. Brian Hutner, clinical psychologist as well as Dr. Rene Buskirk first time on the show, clinical psychologist.

Thank you so much for your time.

Thank you for having a really good show tonight and we thank you for watching.

Next week we have a show on bursitis and tendinitis and Jennifer Bloomquist will be your lovely host that starts seven thirty.

Until then, thanks for watching.

Thanks for your questions tonight.

Good night and good