Absolutes in Chronic Pain Treatment Can Backfire – National Pain Report – Oct 2017 by Ed Coghlan
Beth Darnall PhD is a pain psychologist, noted researcher and Clinical Professor at the Stanford University as well as successful author on chronic pain.
She and her research team have just landed a major grant to study chronic pain. We interviewed her on the grant, the opioid controversy and the National Pain Strategy
Beth Darnall is the main proponent of the “catastrophizing” theory about chronic pain, which is that the patient’s fears of pain supposedly cause most of chronic pain’s amplification.
NATIONAL PAIN REPORT:
“Beth, you wrote a great piece for Huffington Post last year that argued more needs to be done to address chronic pain than just limiting opioids.
Yet it seems a year later, little has changed.
The attack on opioid use has intensified but alternatives are seldom heard. Thoughts?”
“Humans tend think in binary terms and we are certainly seeing that play out with opioids.
It’s not a black or white issue. We need to allow for the grey, and that means treating each patient with respect for their individual factors.
That does not mean that medications and opioids have no place in pain care because they do.
Since she originally insisted that “curing” catastrophizing would cure chronic pain, she has backtracked a bit and admitted that some chronic pain is not “curable” and should thus be medicated, even with opioids, if necessary.
Getting away from the binary thinking allows us to appreciate that physical, self-management and psychological approaches are important for each and every one us – regardless of whether opioids are taken or not.
Yes, regardless whether opioids are taken
Many people who use these modalities find that their medication use is reduced, but not for everyone.
In the current political climate absolutes in either direction will backfire against best patient care
But at the end of the day patients need better access to skilled providers and treatments such as physical therapy, cognitive behavioral therapy for pain, Mindfulness Based Stress Reduction, and chronic pain self-management.
Insurance barriers often prevent patients from accessing this care. And, often patients cannot find skilled therapists where they live
We need policy changes to better support insurance coverage for non-drug pain treatments, and we need better federal investment in chronic pain treatment education for physicians, psychologists, and physical therapists. Ultimately, we need to improve access to the lowest-risk evidence-based pain treatments.
NATIONAL PAIN REPORT:
“I recently spoke with Bob Twillman, executive director of the Academy of Integrative Pain Management who was arguing that implementation of the National Pain Strategy is slow to non-existent. Do you agree?”
Yes. Dr. Twillman is spot on. A federal task force is being developed, so that is promising. But solutions have been slow while the opioid reduction policies have been quickly implemented.
I feel she was a big part of this herself, by pushing the idea that chronic pain was a psychological problem.
She should have been smart enough to know the media would run with this idea and forget all about who would pay for lengthy therapies and who would study the outcomes of forced opioid reductions.
It’s easy for me to play armchair quarterback, but I wish policies that targeted improved non-drug pain treatment had been implemented before opioid reduction policies were enacted.
Many patients have been traumatized and suicide has been a horrifying outcome for some.
I wonder if she feels any guilt about this when her psychological causes were taken as absolutely true for all pain patients, who were then denied the medical care (monitored opioid therapy) they really needed.
I understand the rationale of federal and state policies, but the implementation has not been supportive of patients with chronic pain with tragic consequences.
A short sound bite is that our thoughts, emotions, stress, and choices all impact our pain and can make it better or worse.
Still, she only talks about mental causes and ignores all physical reasons for chronic pain, like the lesions and scar tissue from failed surgeries or the defective connective tissue of EDS.
If you don’t have the right information and formula to help keep your pain as low as possible, you will need more medical care to manage symptoms for you. That’s a trap.
Opioids or no opioids, I encourage everyone to learn everything they can to train their brain and body toward relief. It’s not a one-off solution
Pain management is a lifestyle.
These may be the truest words she has ever spoken.
Just like someone manages diabetes with a focus on healthy daily behaviors, chronic pain self-management is dedication to active, empowered living.
NATIONAL PAIN REPORT:
“You were just awarded a sizeable federal grant. Congratulations. What will it allow you to work on for the benefit of chronic pain treatment?”
“The Patient-Centered Outcomes Research Institute awarded me and my research team $8.8 million to conduct a multi-state study to help patients with chronic pain reduce pain, opioids and associated risks.
We aim test the ability of behavioral treatments to facilitate pain and opioid reduction.
Nobody wants to take opioids, patients just want less pain. It is important to note that we are not forcing anyone to reduce their opioids in this study.
We are only studying patients who want to enroll in a patient-centered opioid reduction program – it is voluntary.
By issuing these disclaimers, it seems she may have been accused of being a bit too “encouraging” about opioid reductions, even in the face of patient protests.
We aim to provide patients who wish to reduce pain and opioids, their families, and their physicians with the evidence they need to successfully meet these health goals.”
Original article: Absolutes in Chronic Pain Treatment Can Backfire