Complexity and collaboration

Abstract

Chronic low back pain and diabetes are two of the most common chronic concerns in primary care. Each is associated with increased depression/anxiety symptoms, decreased functioning, and higher general psychosocial distress. These patients can be difficult for the primary care provider to refer to a mental health provider for a variety of reasons. Patients resist the referral and feel blamed for the way they feel about their medical concerns. They may also feel blamed that they are not doing everything they can to take care of themselves and feel that the medical provider does not understand the impact of illness on their life. They may even wonder if the medical provider is going to be as attentive to physical symptoms if they are psychologized. Finally, when pain is treated with addictive, narcotic medications, the potential for conflict and miscommunication is high. The case involving Sergio is an excellent example. © 2008 Springer New York.