SDH

[Anirudh Penumetcha]

I saw a middle aged gentleman with multiple cardiovascular risk factors along with chronic pain due to musculoskeletal etiology. Review of his EMR and subjective history appeared to show his compliance with medication with pain control. As physicians (in these times, with noted conscious governmental and medical emphasis on safe prescribing practices) it is not uncommon to face this dilemma. It would be appropriate to implement the psycho social model of clinical care in this scenario. It was evident that chronic pain and medication compliance had been heavily influenced by lack of social support (and inner feeling of loneliness) along with the environment he lives in (not uncommon to be on chronic opiod therapy). Using this model I was better able to connect with him and have a discussion regarding his concerns. In the future it would be beneficial to implement this model to tackle difficult patient encounters.

[Dr. Nnodim]

Ani, thank you for a nice reflection. I take it that you meant that your patient had a “lack” of adherence to his pain meds. I was particularly intrigued by this concept of “loneliness” you mentioned, and its connection to poor pain management/chronic pain and other medical problems. I recently read an article about the association of loneliness to increased morbidity and mortality. I’m interested in your view on the role of loneliness in the health experience and outcomes of your patients and how you or I as physicians could better tackle it.
I’m also interested in how you applied the biopsychosocial model to this patient. Looking forward to your response.

[Author]

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