Benefits of depression screening in orthopedic care


Recent research into the relationship between pain management in orthopedic care and depression has shown that reducing depression may help orthopedic patients with their pain, Practical Pain Management reported Nov. 23. 

"There's a synergistic relationship between pain and mental health conditions such that the pain may make you more depressed or anxious," Robert Twillman, PhD, associate professor of psychiatry and behavioral sciences at the University of Kansas School of Medicine, and pain management psychologist at Saint Luke's Health System in Kansas City, Mo., told the publication. "And when you get more depressed or anxious, you experience the pain as being greater."

Evidence has shown treating depression may help these individuals with their pain management, according to the report. 

A research team at the department of orthopedic surgery at Atrium Health Musculoskeletal Institute in Charlotte, N.C., found that currently, less than half of orthopedic surgeons are likely to screen for mental health issues in patients. Only 27 percent would refer a patient to treatment for any mental illness, according to the study. 

The Atrium researchers suggest orthopedic surgeons screen patients using the Patient Health Questionnaire, being proactive in providing access to mental healthcare and prescribing antidepressants, and keeping up with patients by phone. They also recommend transferring pharmacological management to a primary care physician or behavioral health facility after one month. 

The research team also acknowledged challenges with the ongoing opioid epidemic, lack of clinic resources and orthopedic physicians' comfort level with addressing mental health issues. 

Dr. Twillman believes the issue is not with screening patients, but with clinician intervention and ease of access to mental health services. 

"There just aren't enough skilled therapists around to work with pain patients," Dr. Twillman said in the report. "Mental health services are a real challenge. I've been here at Saint Luke's Health System in Kansas City for three years. I'm integrated as part of the system, but it still takes six months to see me."

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