Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Iatrogenic

Iatrogenic disease is a condition which is caused by a physician (Iatros means “physician” in Greek, and -genic, means induced by”). We see far too many iatrogenic problems in the injured worker being treated for pain, and this also occurs with patients incorrectly recommended for surgery or other procedures.

For example, the patient with chronic back pain may be started on medication but continue to complain. The medications are increased. They are also given medication for break-through pain. Their medications are changed, altered in schedule and substituted. Often they wind up with a drawer full of “discontinued” medication. They are prescribed other medications to counter the side effects of their pain medications.

Their appointments become nothing more than a recitation of their subjective pain complaints. Treatment becomes nothing more than the dispensing of drugs.

Even when their (co-morbid) depression is recognized (which is unfortunately quite rare), they are not adequately or appropriately medicated, and certainly no referral for care for the depression is made.

Indeed, depression is too frequently the result of opioid use as the brain’s chemistry is increasingly altered, and the patient loses the ability to self-regulate sleep and mood.

When the physician then feels concern for the patient’s narcotic use, they may tell the patient that he/she need to come off the medication, cannot remain on it forever, and that the physician is no longer comfortable prescribing. Often, they are referred to someone else who does not believe in the use of narcotics, and the drugs are abruptly halted. Or their “case” closes, and access is suddenly nonexistent.

In my screening of patients, I determine if the patient believes or states, among other things, that:

1. they will need medication for many years
2. their pain is unique and requires more medication than others
3. they are borrowing, hording or mixing medication from multiple providers
4. their worst fear is loss of access to narcotics

Often the patient develops a hostile-dependent relationship with their physician. They resent that the physician is not doing more, but are nonetheless dependent upon this provider for narcotics.

At the risk of being obvious, this situation, the depression, and the distorted beliefs need to be addressed as early in the treatment process as possible.”

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