Table 4.
A primer for managing patients with PSPS (based on North et al 2010)6
| • Treatment is orchestrated by a single physician who develops a therapeutic alliance with the patient and follows the patient on a regular basis. The aim is to protect the patient from iatrogenic morbidity from unnecessary medical procedures and to support the patient in developing healthy coping behaviors and making optimal decisions. |
| • Success will depend on winning the patient's confidence without allowing her symptomatic behavior to exhaust the physician's sympathy. |
| • The physician should strive to discuss the patient's life problems, concerns, and goals achievement rather than simply ordering additional tests and X- rays or yet another medication or more surgery without objective indications of their necessity. |
| • The most frequent complications are repeated surgical procedures (with its comorbidities), drug dependence, martial instability, and suicidal attempts. Avoid surgery, other invasive procedures, and medications that are potentially dangerous or with abuse potential unless clearly indicated based on objective signs, symptoms, and sufficient diagnostic evaluation. |
| • Cognitive behavioral therapy appears to be effective based on a review of published randomized, controlled trials.24 Other types of psychotherapy or counseling might be helpful and a referral to a clinical psychologist or other mental health professional maybe indicated. |
| • Psychiatric consultation may be helpful in reducing the extent and cost of medical care based on a controlled, randomized study.25 Some patients may be reluctant to consult a psychiatrist, but psychotropic medications may help to alleviate the symptoms of depression and anxiety. One-time diagnostic evaluation by a psychiatrist may be helpful to provide guidance to the treating physician. |