The Co morbidity Paradigm

Managing Pain, Anxiety & Insomnia

On the 23^rd of April Dr. Martin Katzman from Toronto delivered a lecture on the above at NOSMs East Campus. His primary argument was that pain, anxiety and sleep disorders tend to occur in conjunction with one another and should all be treated since they can greatly affect one another. In an interesting an engaging talk he certainly conveyed the message to the clinicians present.

Sadly the pervasive lapse in logical arguments has not spared the great mind of Dr. Katzman. When trying to describe the ethological relevance of anxiety and when he becomes disordered he said.

"You're more likely to likely to die on the toilet than on an airplane"

Arguing that if people were truly afraid of dying they would avoid toilets, not airplanes. Sadly, Dr. Katzman failed to consider that people who die on toilets would die regardless of where they are as opposed to people who die on airplanes, at least when they crash, generally would not have died if they did not board that flight. Whereas boarding an airplane increases your risk of dying, albeit by a miniscule amount, sitting on a toilet does not.

Despite the excellent research done by Dr. Katzman and the S.T.A.R.T. Clinic I was also saddened that no real attention was given to primary versus secondary and tertiary disorders. Since suffering from chronic pain can cause sleep disturbances and anxiety which would not occur if there was no pain. Therefore, the population who suffers from all three types of disorders is heterogeneous. Since a person's symptoms differ from day to day, asking clients to subjectively describe the severity of their symptoms over an extended period of time (I'd reckon a month would suffice). Using the magic of lag/lead and path analyses one can make predictions about which disorder causes the others, if any since there are likely individuals who suffer from all three independently of one another. Doing this can minimize pharmacological intervention by only treating the primary condition thus avoiding the myriad side-effects of modern drugs, which in some cases will exacerbate the other disorders.