Dr Arwen Podesta: Better Communication and More Compassion Needed for Patients With Pain

There is a stigma that comes with being addicted to opioids, even if they are prescribed to manage pain, that can hurt the care patients need to receive, said Arwen Podesta, MD, ABPN, FASAM, ABIHM, of Tulane University.

What are the challenges of caring for patients with opioid addiction who have other treatment needs?
We've been so compartmentalized into siloes, and so psychiatrists work over here, pain doctors work over here, primary care doctors work over in this other silo, and no one is really taking the lead unless you're in a multidisciplinary team setting, which is rare as an outpatient. So, we don't communicate enough. And I think that is the main thing: communication between practitioners. And even having patients wanting to compartmentalize, which I've seen before too. They might sometimes want to have a good relationship with one, and an antagonistic relationship with another, and being able to share that information is so useful.

Another thing is stigma. I have patients tell me all the time that they're struggling with opiod addiction, and they have true pain, and they go in after a major event and they go into an emergency room, and they say, "No, I don't want pain medicine, I need something else," and tney get judged. And they basically get kicked out of the ER, because the ER doctor—this happened last week to one of my patients—the ER doctor didn't find that he could do anything for the patient. So, he said, "I can't help you." That's not very common among physicians, but it certainly happens.

And there's a stigma that comes with addiction with opioid misuse, even with just being on opioids on a standard daily basis as used for pain management, or any other thing. Even psychiatric diagnoses have a stigma. So I think we need to communicate better and be able to be more compassionate to all of the disease states of our patients.
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