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Christopher T Caldwell, D.O. Medical Director, Montana Spine and Pain Center

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

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Christopher T Caldwell, D.O. Medical Director, Montana Spine and Pain Center

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  1. Theobject of thephysicianistofindhealth. Anyone can finddisease- 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

  2. Conflict of Interest Disclosure:Christopher T. Caldwell, D.O. Has NO real or apparent conflicts of interest to report.

  3. Painishard-wired to fear • Fear of Damage • Your back isShot • What a Train Wreck • WorstI’veeverseen • Fear of theFuture • LuckytoNotbeParalyzed • You’llend up In a wheelchair • Fear Sells • You’llend up NeedingSurgery

  4. NeedtoCompensateforpatients’ • NegativeAttentionBias • Catastrophizing • Fear-avoidance • Lowself-efficacy • False beliefsaboutpain

  5. Stop Catastrophizing!!! Inflammatory • Degenerative • Arthritis • Stenosis • Annualtear • Disc protrusion • Facetarthropathy • Bonespur • “Out of place”

  6. “Translate” forthepatient Inflammatory Reassuring = No Danger Candlesonyour cake Wear and tearchange Lessbreathingroom Normal wear Gravitywins “Knucklejoints” Calciuminside a tendon Stuck • Degenerative • Arthritis • Stenosis • Annualtear • Disc protrusion • Facetarthropathy • Bonespur • “Out of place”

  7. FindingHealthisaboutLanguage • Radiologistsaren’ttalking to patients • Don’treadreports to patients • You are talking to theirlimbicsystem

  8. 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

  9. 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

  10. 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 tobacco History of poly-substance abuse, clean since age 42 Orthostatic hypotension Hypogonadism Depression with anxietyand insomnia Hepatitis C Chronic lumbar pain with radiculopathy • Arrives by wheelchair, flat affect, on oxygen • Doctor appointments are only time he leaves house

  11. 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?

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