Considering The Mind - 08.02.2014

Dr. Mark Skellie, Psy.D., provides insight on the mental health services he offers patients of Louisiana Pain Specialists and on coping with chronic pain

By Lucey Wright, M.S.

Dr. Mark Skellie has a profound and distinctive understanding of pain. While the physicians at Louisiana Pain Specialists focus on the physical causes and treatments for pain in the body, Dr. Skellie’s knowledge of pain centers on the workings of the mind. He was trained at the Georgia School of Professional Psychology, practiced in the Veteran’s Administration system, and began a private practice before joining Louisiana Pain Specialists. As a Psychologist specializing in Clinical and Health Psychology, he is an expert in how pain and physical health problems can affect mental and emotional health.

For many of the patients he works with at Louisiana Pain Specialists, their visit with Dr. Skellie is their first interaction with a mental health professional. “A lot of people have a fear that a psychologist is a mind reader or some kind of magician,” he says, “But psychology is a science that uses knowledge of people and the human condition. When it comes to any mental healthcare, how in depth it gets is up to the client. You only talk about what you want to talk about.”

Since joining the team in May 2014, Dr. Skellie has contributed to the comprehensive approach to pain intervention at Louisiana Pain Specialists. He explains, “My clients at Louisiana Pain are generally mentally healthy, but are coping with a chronic pain condition. I work with the patients and physicians to ensure opioid medication compliance, carry out screenings for patients who are candidates for Spinal Cord Stimulator trials, and see patients with depression or coping skills
issues related to their pain.”

Dr. Skellie provides insight on the mental health services he offers patients of Louisiana Pain Specialists and on coping with chronic pain.

Opioid medications and mental health

Prescription opioid abuse is a major issue in the United States. The Center for Disease Control (CDC) reports that almost half a million emergency department visits a year are due to people misusing or abusing prescription painkillers. In the most recent year reported by the CDC, prescription painkiller overdoses killed nearly 15,000 people in the U.S.; over a threefold increase from 15 years ago.

For the physicians at Louisiana Pain Specialists, their patients’ safety is the top priority. It is very important to them that the patients to whom they prescribe opioid medications for pain are using them safely and correctly. To ensure the safe use of opioid medications, every patient who is prescribed these medications signs a contract in which they agree to use the medications as prescribed, and to avoid filling opioid medication prescriptions from other providers.

The physicians have also enlisted the help of Dr. Skellie. One of the most important services he offers at Louisiana Pain is opioid compliance screenings for patients who have violated their contract. “We are setting up a structure for patients to go through who are in violation of their opioid medication contracts, to assess whether they are candidates for continuing
medication management. If someone has a violation, I will meet with them two to three times before their medications run out, so that I can provide the physician with recommendations.” These meetings give Dr. Skellie the opportunity to counsel patients on appropriate use of their medication and ways to improve their quality of life.

One common contract violation is the overuse of medication for spikes in pain. Dr. Skellie explains, “People who live with chronic pain in a healthy way accept that there are going to be times when they will experience some pain. It is when someone expects to always have a zero on the pain scale that they might have some difficulty with medication management. Opioid pain medications are typically meant to be taken in a stable, consistent way to cover pain. Contract violations can occur when a patient’s pain is not fully covered by their normal medications, and they are trying to be pain free more often. It’s when they start making choices that are not what the doctor recommends that they can begin a problematic cycle.”

Another challenge that Dr. Skellie helps patients face is the use of their pain medication for emotional, rather than physical pain. “Pain medication is designed for physical pain. It can become an addictive process if people take their pain medications in order to deal with emotional issues.”

He explains further, “Chronic pain patients who become addicted to pain medications aren’t like other typical addicts. They can form a difficult relationship with pain and their medications that can get out of control. Little mistakes can mean running out of pain medication, which opens the door for other mistakes, which in the worst case can lead to a spiral of illegal and
dangerous behaviors.”

Dr. Skellie helps patients to prevent these issues and make healthier choices. “It all comes down to control, and good communication with the doctor. I help patients manage pain in adaptive ways by using psychological strategies to deal with low-level pain spikes or emotional pain without taking more medication than prescribed. Patients also need to understand that when they are having break-through pain, it needs to be communicated to their physician, and the physician may be able to
manage their medications in a way that could help.” “Also, sometimes people on long term opioid medication therapy do not take other actions that may help alleviate their pain,” Dr. Skellie says. “They can become sedentary, and just rely on their medications to relieve their pain. Their pain is managed by the medication, but it could be even better if they could get up and do activities they enjoy, such as go to church or see friends. Instead, they may end up staying at home. I encourage folks to get up and do things as much as they can.”

Studies have shown that physical and social activities are beneficial for chronic pain. For pain conditions from back pain to fibromyalgia to arthritis, the physical activities of daily living can reduce pain and improve function, mobility, mood, and quality of life for most adults. “I’ve worked with a lot of people with a variety of pain. Stress, anxiety, and anger make pain
more salient and noticeable. But when you are watching your grandson’s first football game, you might forget for a little while; your pain may become less challenging.”

Spinal Cord Stimulator trial screenings

Spinal Cord Stimulation (SCS) is a method that physicians use to manage chronic pain and improve quality of life of patients who suffer from back, neck, arm, or leg pain. It works by blocking pain signals before they reach the brain, with a small system (similar to a pacemaker) implanted within the body. The system replaces pain with a feeling of gentle massaging or, in some cases, simply the absence of pain.

The physicians at Louisiana Pain refer patients to Dr. Skellie for screening prior to their trial Spinal Cord Stimulator procedure. “It’s a simple interview over about an hour,” he explains. “Many patients ask me why they have to come see me. It has to do with the fact that there are some mental health concerns that make following doctor’s orders challenging. Severe problems must be identified and addressed before the trial. Stable emotional health is one of the best predictors of success
for the Spinal Cord Stimulators.”

The screenings can have positive effects, as they give Dr. Skellie the chance to discuss coping strategies with patients who he otherwise might not be able to reach. “The screening requirement allows for a clinical mental health interview for people who may have never seen a mental health professional before,” he says. “Giving someone a simple tool that they can use and
feel better, it opens a door. It can help and be really good for clients.”

“The first strategy is focusing on awareness. If you aren’t paying attention to your stress level, then you are just experiencing it. You have to become aware of your stress triggers. When you focus on being aware, you may notice that when you speak to a certain person, you get more stressed, tighten up, and experience more pain.”

Coping Strategies

Dr. Skellie describes the strong connection between the mind, the physical body, and relationships with others, and how this connection is affected by chronic pain. “It’s a cycle. Chronic discomfort can lead to depression, anxiety, and irritability. That can open up a range of interpersonal challenges. In turn, social challenges and depression make pain more difficult to
deal with.”

Dr. Skellie believes that with effort, this cycle can be broken. “The first strategy is focusing on awareness. If you aren’t paying attention to your stress level, then you are just experiencing it. You have to become aware of your stress triggers. When you focus on being aware, you may notice that when you speak to a certain person, you get more stressed, tighten up, and experience more pain.”

Dr. Skellie says that awareness must extend to joys, not just stresses. “What are you doing to cope? What helps you? A range of things can work really well.” He suggests, “Our relationships with others can help. Is there a friend or family member that you have loving, funny, enjoyable interactions with? If you can really enjoy your time with someone, particularly if that person
can make you smile, your pain may become more manageable during that time.”

Finding distractions from pain can also be helpful. “Helping others out with their own problems can take the focus off the pain. For example, listening to a child’s challenges or successes from her school day can allow for some diversion. Generally, anything that helps with relaxation is great. Organized relaxation activities, yoga, mediation, and prayer groups can all focus the mind and calm the body.”

Finally, Dr. Skellie suggests getting back to the basics: the breath. “Taking a moment to take a few deep breaths can be a huge help in coping with pain and the stress it causes. Slow, conscious breathing is one of the first things that I teach clients. This is something that they can do to cope at any time, even when they are in front of people.”

Dr. Skellie’s message for those with chronic pain is clear: the mind can be used to help the body. “Chronic pain is certainly not something that is ‘only in your mind’, but the mind can be a powerful tool to cope with the challenges of living well with pain. Living well despite your pain takes a toolbox approach choosing from strategies that work, such as good communication with your medical team, skillful use of effective coping strategies, support from loved ones, the ability to find laughter and levity in your daily life, the resilience to face challenges with an adaptive attitude, and a willingness to keep striving to make each day better in at least some small way.”