Managing Heartsink Patients with MUPS: Review of Evidence on Approaches that can Minimize or Reverse Impairment and Disability

TRACK: OEM Clinical Practice

Jennifer H. Christian, MD, MPH, FACOEM, Webility Corporation, Wayland, MA
Caruso Garson, MD, MPH, FAADEP, FACOEM, Garson M. Caruso, MD, MPH, PA, Mechanicsburg, PA

“Heartsink” has been used to describe that feeling we often get when working with patients with chronic pain, disabling symptoms, and protracted work disability whom other physicians have been unable to help or have already harmed. The deficiencies of the biomedical model to explain the suffering of patients with treatment-resistant symptoms and disability is well known. So are the inadequacies of
conventional medical care (diagnostic procedures, pills, procedures and surgery) for resolving the patient’s distress and life disruption. These cases are high cost and a major concern for payers. What can we learn from the medical literature that can help us identify the bio-psycho-socio-economic (BPSE) factors that increase the risk for becoming heartsink patients? What does research tell us about clinical
interventions that are effective in preventing or reversing work disability related to chronic pain or medically unexplained physical symptoms (MUPS)? This session will review the evidence base and present ideas for putting the research evidence into practice in the OEM setting, with time for audience Q&A.