Christopher T Caldwell, D.O. Medical Director, Montana Spine and Pain Center
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The object of the physician is to find health.
Anyone can find disease- A. T. Still, M.D., D.O.
Christopher T Caldwell, D.O.Medical Director, Montana Spine and Pain Center
Board-certified, Neuromusculoskeletal Medicine
Boar-certified, Osteopathic Manipulative Medicine
Fellowship-trained, Pain Medicine
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Conflict of Interest Disclosure: Christopher T. Caldwell, D.O.
Has NO real or apparent conflicts of interest to report.
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Pain is hard-wired to fear
• Fear of Damage– Your back is Shot– What a Train Wreck– Worst I’ve ever seen
• Fear of the Future– Lucky to Not be Paralyzed– You’ll end up In a
wheelchair
• Fear Sells – You’ll end up Needing
Surgery
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Need to Compensate for patients’– Negative Attention Bias– Catastrophizing– Fear-avoidance– Low self-efficacy– False beliefs about pain
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Stop Catastrophizing!!!
Inflammatory• Degenerative• Arthritis• Stenosis• Annual tear• Disc protrusion• Facet arthropathy• Bone spur• “Out of place”
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“Translate” for the patient
Inflammatory• Degenerative• Arthritis• Stenosis• Annual tear• Disc protrusion• Facet arthropathy• Bone spur• “Out of place”
Reassuring = No Danger• Candles on your cake• Wear and tear change• Less breathing room• Normal wear• Gravity wins• “Knuckle joints”• Calcium inside a tendon• Stuck
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Finding Health is about Language
• Radiologists aren’t talking to patients– Don’t read reports to patients
• You are talking to their limbic system
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Case 1• MD, 56 yo female, changing insurance – establishing
with new pcp• 9 years of low back pain• 6 years of “total body” pain• Methadone 90 mg three times daily• hydrocodone/acetaminophen 5/325mg as needed – up to
6 tabs daily• Pain Diagnosis : chronic pain syndrome, fibromyalgia• Other Medical history: Type II diabetes, hyperlipidemia,
fatty liver disease, obesity, remote tobacco history, depression, insomnia
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Case 1 – More History
• Immigrated from Cuba in 1997 where she was a lawyer – Spanish speaking only
• In US worked at Goodwill sorting clothes• Lived with alcoholic husband and 2 children
Husband left soon after arriving and currently only one child living with her
• Injured back at Goodwill in 1998 and some time after that was declared disabled
• Brought Mother over in 2002
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Case 2
• BG 56 year old male• Active problem list
HIV+• Bacterial pneumonia , twice in last 5 years• Neuropathy – HIV?• lipodystrophy
COPD > 40 pack years of tobaccoHistory of poly-substance abuse, clean since age 42Orthostatic hypotensionHypogonadismDepression with anxiety and insomniaHepatitis CChronic lumbar pain with radiculopathy
• Arrives by wheelchair, flat affect, on oxygen• Doctor appointments are only time he leaves house
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Challenging discussions
• Are you saying this is all in my head?• It’s really not safe for a person with a
condition like mine to do _____.• But I have something real going on, so all
of this doesn’t really apply to me.• I need to get my pain under control before
I can get back to_____.• But what are you going to do for my pain?