Beyond Pain and Addiction: The Triple Diagnosis

The medical field has long recognized the complex intersection of chronic pain and addiction, but a critical third component is often overlooked. In this MEC Connect Expert Insights episode, “Beyond Pain and Addiction: The Triple Diagnosis,” our Chief Medical Officer, Dr. Fernando Branco, shares his approach to treating patients beyond the traditional pain-addiction model.

Dr. Branco discusses the framework of "triple diagnosis" in pain medicine. His decades of experience revealed that addressing underlying psychiatric conditions alongside pain and substance use disorders is critical for successful treatment outcomes. He offers expert insights into:

• The interconnected nature of physical pain, substance use, and mental health.
• Why a triple diagnosis framework could enhance treatment approaches for some of medicine's most challenging cases.
• The importance of considering psychosocial factors, such as family dynamics, environmental stressors, and social support systems, that can either facilitate recovery or create additional barriers. 
• How underlying psychiatric conditions consistently influence treatment outcomes. 
• Why pre-existing conditions create a complex treatment landscape that demands a more comprehensive approach.

Listen now to hear about Dr. Branco’s holistic approach to viewing patients as "global persons" and the paradigm shift that moves integrated patient care beyond the common dual focus of pain and addiction.

Chapters

• 0:00 Introduction to MEC Connect Expert Insights
• 0:34 Dr. Branco Introduces Triple Diagnosis Concept
• 1:30 Additional Psychiatric Diagnoses Explained
• 4:13 Global Approach to Patient Treatment
• 5:45 Episode Closing and MEC Focus

Transcript

Sara Hance: 0:03

Hello, this is MEC Connect Expert Insights, a companion series to our main MEC Connect podcast for Midwest Employers Casualty. I'm Sara Hance and in these Expert Insights episodes, you'll hear from subject matter experts as they share practical tips and strategies on a variety of topics related to workers' comp and claims management. Of topics related to workers' comp and claims management, Today, Dr. Fernando Branco, AVP of Claims and Chief Medical Officer, will discuss triple diagnosis. Now let's hear from Dr. Branco.

Fernando Branco: 0:34

Hello, thank you, Sara, for the introduction. Yes, my name is Fernando Branco. I am a physician. I did my residency in physical medicine rehabilitation, but I'm also a board certified in pain and addiction and that's why this topic today, the triple diagnosis. That is something that I started using with my patients during my decades of treating this kind of cases.

Fernando Branco: 0:59

It's quite common to hear the double diagnosis. There is a pain and addiction. Common to hear the double diagnosis, that is, a pain and addiction, and I tried to give another dimension to this situation, calling it the triple diagnosis, because what I found out was, as I treat my patients, that they all had pain. You know, some started with, you know, minor pain or maybe some major trauma, neuropathic pain, and then unfortunately, as you know from the narcotic epidemic, we end up creating a lot of patients with addiction and that's what I call the quotation mark diagnosis and today we don't use that expression anymore because it became a little loaded in terms of sort of labeling people something negative. You know, when you say, oh, you're a drug addict. Then we sort of changed this to what is now called substance use disorder and it's okay with me In the end, still addiction. Obviously we still can go back into physical addiction and emotional addiction or psychological addiction it's called. There is both in general for almost every drug. But what I noticed is that we had a tendency, as physiatrists and neurologists that work with multidisciplinary teams with this, like we'll have a psychologist in our team or even a psychiatrist and we kept focusing only on the pain and the substance use disorder and there was always something on the background that you know. We're always trying to fight in terms of well, you know what's going on.

Fernando Branco: 2:41

We don't want to bring further diagnosis in here, what I call the additional psychiatric diagnosis, because of course substance use disorder is a psychiatric diagnosis. But I add the additional psychiatric diagnosis something that the patient and most of us have some form of psychological depersonality changes. You know some people have OCD, that is, obsessive compulsive disorder, but those are well managed. But then you can have the disorder that somebody cannot function socially with their OCD behaviors and what I noticed as I was treating these patients we ignore this underlying other additional psychiatric diagnosis that be a personality disorder, let's say OCD, borderline, schizoid personality. The schizoid would be kind of like a more withdrawn person. A borderline personality is definitely the most difficult If that's added to the pain and addiction. They're very difficult patients. I can't go into the details in here, but that is a reality.

Fernando Branco: 3:50

Then you also kind of ignore that somebody that had chronic anxiety, chronic depression, maybe manic depression, or even think something worse, like psychosis, like schizophrenia, and sometimes you're not going to have overtly any of this diagnosis, but they're all there and if you don't acknowledge them in some way, stabilize them, you're going to destroy the treatment because if you only focus on the pain and the substance use disorder, you're going to miss. Of course you need to always be careful because with this kind of situation being in a worker's environment, diagnoses are added all the time. We always need to make sure that we're doing this. But this is a premorbid condition and we'll do some treatment to stabilize that, to help the treatment to achieve its goals, but not to buy that diagnosis.

Fernando Branco: 4:47

I hope you can understand why I wanted to make this emphasis on realizing that there is a possibility, that's other factors and you could even add here psychosocial issues. You know what kind of environment that this person came from, what kind of family they have, what kind of spouse that means you can add in here, as these are factors that disrupt the milieu and also disrupts the patient's treatment. If I could give you a final, just, you know, make sure that when you look at these patients, you look at them globally, and I think that's the idea of the triple diagnosis is to keep in mind that people are not one diagnosis or one issue. We are a global person, a global patient, and you need to look at all the different aspects of this individual if you want to be successful with the treatment. And this will be it for today and I hope you guys have a wonderful day, thank you.

Sara Hance: 5:45

Thank you for tuning in to MEC Connect Expert Insights. Here at MEC, we focus on what matters most worker recovery and better claims outcomes. Our skilled people, proven processes and innovative technology achieve measurable results and creates lasting value. We hope you found Dr. Bronco's insights on triple diagnosis valuable. Stay tuned for more from MEC Connect and more expert insights. Thanks for listening.