"Scientific American" Feature on Treating Pain without Pills

The opioid crisis is forcing doctors to take different approaches to treating pain. In some cases, patients who have been prescribed opioids for years or decades are being abandoned or forced to quickly taper off opioids -- two poor approaches. Other patients are being steered in new directions that can improve pain and function with lower risks. I was honored to be featured in this Scientific American story (May 2017, Author: Stephani Sutherland, PhD) in which the stories of patients are told. Similar to patients I have treated in the past and detailed in Less Pain, Fewer Pills, one featured patient had an astounding result from stopping her opioids while receiving cognitive behavioral therapy for chronic pain (not general counseling).

There are many sides to the opioid crisis. The patients with a clear medical need should maintain access to the medications that work for them-- including opioids. And, there are so many patients taking opioids for whom opioids are not effective for them but have not been offered a different, better pathway that's right for them.

The notion of supporting access to opioids for some while fighting for access to evidence-based alternatives to opioid treatment can and should coexist. It's the same fight: The right treatment for the right patient. 

I invite you to read the May issue of Scientific American and learn more about what we are doing in the Division of Pain Medicine at Stanford University. Catch a glimpse of my view of how pain psychology is working to help patients with chronic pain reclaim their lives.

Using Psychology to Help People Have Less Pain After Surgery

At the Stanford Systems Neuroscience and Pain Lab, one of our active research studies is focused on how to help prepare people who are heading to surgery. We are equipping them with the information and skills they can use to reduce their own distress and discomfort after surgery. Ideally, this helps people need less pain medication. The program is called "My Surgical Success", and we are testing in women undergoing surgery for breast cancer at Stanford University.

Author Christina Frangou features "My Surgical Success" in her article published in Pain Medicine News this week. Read it here and learn what we and others (including surgeons) are doing to approach pain control from different angles.

Pain Psychology Resources Available to You Right Now


Optimize your mind-body connection with information and resources that empowers you to reduce pain and its impact on your brain and body.

(1) Understanding Pain in less than 5 minutes, and what to do about it! (5:00) View it here.

(2) Learn out Pain Psychology (12:47) View it here.

(3) What Is Pain Catastrophizing? (6:53) View it here.

(4) Free Online Mindfulness-Based Stress Reduction (MBSR)  8 week course. Learn more here.

(5) Free Mindfulness App and Guided Meditations. Download here.

(6)  Free Mobile Relaxation AppBreathe2Relax(from the Department of Defense) Download here.  

The Great Need for Pain Education in Psychology and Mental Health Training

Clinical Psychiatry Advisor features Beth Darnall and the work of the entire Pain Psychology Task Force of the American Academy of Pain Medicine in the August 2016 article "The Importance of Pain Psychology Curricula in Training and Education." (Author: Tori Rodriguez, MA, LPC).

Read about the national needs assessment that was conducted in almost 2,000 individuals across 6 key stakeholder groups in the U.S., and published in Pain Medicine earlier this year. Learn why a major solution to the pain treatment crisis includes better integration of pain education into mental health education at all levels of training.

Read the Psychiatry Advisor article here

Read the original Pain Medicine research article ("Pain Psychology: A Global Needs Assessment and National Call to Action", 2016) here.

"The Opioid-Free Pain Relief Kit" - FREE Copy, Enter to Win!

My inspiration for writing this second book was the patients I treat -- and the millions of other people living with pain who are seeking relief. I was also inspired by the legions of healthcare providers who are desperately looking for accessible, low-cost, non-opioid solutions to offer their patients.

The Opioid-Free Pain Relief Kit is an easy-to-read resource that’s chock full of information that patients can put to use immediately. Written at the 8th grade level, it is for the everyday individual who is missing crucial information about their pain: How they can best help themselves.

More than ever, there is pressure to reduce use of opioids to treat chronic pain and this leaves many patients wondering, “How will my doctors and healthcare team help me?” Perfect for handing out or recommending at point-of-care, this book serves as a foundation to emphasize that treating pain is not a passive process. Patients don’t want more pain, they simply lack the information they need to do it differently and reclaim their control from pain.

Best results are achieved when patients follow a plan and regularly use evidence-based skills that reduce pain processing in their nervous system—thereby reducing need for pain medication. This book gives them the understanding, the skills, and the plan they need to get started today:

  • Pain education about the essential role of psychology in the experience of pain
  • Evidence based pain psychology skills
  • Comes with a binaural enhanced pain management CD / audiofile
  • Simple and engaging exercises to develop self-management practices
  • How patients can reduce their need for pain medication through self-management (improved self-care, activity, sleep, pleasurable activities, exercises that reduce pain processing).
  • How to train the brain away from pain.
  • Self-empowerment by developing a “Complete Pain Relief Kit” based on evidenced-based skills and principles they learn in the book.
  • The slippery slope of opioids; how to minimize opioid use and how to keep yourself safe.
  • Generous use of graphics and illustrations deliver key messages visually and make reading the book fun.
  • Each chapter contains Beth’s Tips; think of it as “Your pain psychologist in a book!”

This book is perfect for all patients with pain—whether on or off opioids. It puts the patient in the driver’s seat—so they need fewer doctors and fewer pills! If purchased in bulk the book less than $6 per unit. Very low cost was our goal and I think we hit the mark!

Enter to win your free copy from Goodreads! Hurry, contest closes soon (August 3, 2016)!

"Less Pain, Fewer Pills" on The Healing Pain Podcast

I was excited when Dr. Joe Tatta invited me to be on "The Healing Pain Podcast" about psychology and its role in pain management, and symptom and medication reduction. We covered a lot of ground in our hour-long video interview, including what's needed to help patients suffer less and gain control over their experience. I talked about my new book, The Opioid-Free Pain Relief Kit ©2016 and learned that Dr. Tatta has a book of his own coming out in early 2017. A DPT who promotes the biopsychosocial model of pain treatment -- and educates the public about it -- he is a tour de force in the field.

Thank you Dr. Joe for a great and lively chat about reducing pain and improving function.

Our JAMA Internal Medicine Study of Opioid Risks After Surgery Published Today

Stanford Medicine News Center covers new research led by Dr. Eric Sun from the Stanford Division of Pain Medicine. The study, published in JAMA Internal Medicine, describes the incidence of and risk factors for chronic opioid use among opioid-naïve patients in the postoperative period. The study highlights which patients may be particularly vulnerable. Read the JAMA story here.

The Stanford Medicine News Story (author: Tracie White) includes a discussion about how to treat pain differently to minimize risks. I was pleased to weigh in about how to treat pain comprehensively with pain psychology skills, and to describe our current presurgical research on this topic. 

Dr. Sun's coauthors included Dr. Laurence Baker, myself, and Dr. Sean Mackey.

An International Furor Over Opioids and Long-term Solutions for Pain

Opioid limits alone are not good pain care policy. In the international furor over opioid overprescribing and overdose deaths, we must extend beyond the current zero-sum conversation that pits overdose deaths vs. patients who need access to pain care. This Huffington Post explores what's needed so everyone wins. 

Stanford Back Pain Education Day 2016! FREE!

Please join us for the 2016 Stanford Back Pain Education Day taking place on September 11, 2016 at Cemex Auditorium on Stanford University campus.

If you have back pain, please join us for an exciting day filled with lectures from Stanford pain experts and information on community resources, research opportunities, and state-of-the-art back pain treatments! 

In addition to great information and resources, all attendees receive complimentary lunch, goody bags, and other giveaways!

Registration is now full. Please join the waitlist.

Topics Covered

  • Pain and the Brain
  • The Psychology of Pain Relief:  Train Your Brain Away from Pain
  • Back Pain Self-Management: Help yourself feel better and live better
  • Pain and Relationships
  • Movement as Medicine for Back Pain

Read about last year's event: http://stan.md/27llFp2

Insurance Restricts Opioids - Now What for Pain?

The National Pain Report publishes a feature interview to address the question - what happens after opioids are limited or stopped? Patients with chronic pain are being unfairly punished for for the actions of addicts. And, importantly: how do we treat pain differently?

Beth Darnall, PhD addresses all of these questions and more. Read the article here.

Tapering Off Prescription Opioids: 7 Tips for Success!

Dr. Darnall's Healthgreatness article on Opioid Tapering HERE.

The specter of tapering off prescription opioids may be fraught with anxiety for the people taking them. Patients often worry about how they will manage the difficulty of the taper process. Patients also often mistakenly believe they will have more pain without opioids because they may have experienced more pain when they missed a dose and had withdrawal symptoms.  With the right formula and plan, tapering can go smoothly and easily-- without more pain.  Beth Darnall, PhD helps set you up for success with these 7 Tips for Prescription Opioid Tapering in this Heathgreatness article!   

Feature Interview with Pain Pathways Magazine - Less Pain, Fewer Pills

I was honored to be interviewed by Pain Pathways Magazine about Less Pain, Fewer Pills: Avoid the dangers of prescription opioids and gain control over chronic pain (Bull Publishing). Though Less Pain, Fewer Pills published almost 2 years ago, today it is more relevant than ever. In a climate of opioid restrictions, people with pain need alternatives. And, even if opioids are part of your medical plan, the book teaches you ways to reduce their own pain so that fewer pills are needed.

In this interview I discuss my own journey with chronic pain, and how it lead me down a road of working with others, so that their suffering might be lessened. Read the full interview here.

San Francisco Chronicle editorial on the pain and opioid crises, and a national call to action

My editorial published today in the San Francisco Chronicle. Topic: the pain and opioid crises, and what we need to do differently as a nation. The IOM Report, the National Pain Strategy, and the Pain Psychology Task Force at the American Academy of Pain Medicine are cited. 

Dr. Kate Lorig on the National Pain Strategy: The Golden Age of Self-Management

The 2016 National Pain Strategy has placed self-management firmly in the spotlight as a critical pathway to better treat pain in the U.S.

Kate Lorig, DrPH

Kate Lorig, DrPH

Cue Dr. Kate Lorig, the Godmother of Self-Management. Dr. Lorig spearheaded the development of self-management education and treatment at Stanford University 3 decades ago, beginning with the Arthritis Self-Management Program. She and colleagues studied participant outcomes for her program and demonstrated some of the best results for any behavioral or educational intervention -- doubly impressive due to their incredible durability. Randomized controlled trials show that self-management programs confer improvements in self-efficacy and health status -- improvements that are sustained at 4 year follow-up (Lorig KR et al 1993). What's more, similar results are found for the internet-based adaptations of her programs across various pain conditions, including rheumatoid arthritis, osteoarthritis, and fibromyalgia (Lorig KR et al 2008).

What started out as self-management for arthritis has been expanded to HIV, cancer, chronic disease, and diabetes. All of the self-management programs teach participants how to help themselves become more active, manage symptoms, and problem solve effectively. Self-management is all about engaging patients in their own care (click here to learn more about self-management). Her programs are available in every state in the U.S. and in about 30 countries worldwide. They are offered widely in the US in Spanish and English and around the world in 20 different languages. In short, thirty years ago Dr. Lorig began a self-management movement that has literally changed the world.

All of Dr. Lorig's self-management programs have a component of pain education and self-management of pain.

Unsurprisingly, the National Pain Strategy includes language about the need to systematically integrate self-management into pain care.

I took the opportunity to sit down with Dr. Kate Lorig and hear in her own words what this all means.

This is very exciting 30 years ago we started with self-management for arthritis. In fact my first peer reviewed paper focused on how both patients and rheumatologists viewed arthritis pain. We conducted numerous randomized trials on the effectiveness of community based self-management programs for arthritis, pain, and co-morbid chronic conditions.     
People live 99 percent of their time outside of direct medical care. What they do during this time greatly determines their pain, their quality life and also their utilization of the health care system. To live this time most effectively, patients must learn self-management skills, and have the confidence to practice these skills on a day to day basis. Our research has shown us that patient confidence of the key to successful self-management. Fortunately, with carefully crafted programs with emphasis on action planning, modeling and reinterpretation of symptoms, confidence can be enhanced and in turn improve self-management. Over the years we have conducted many randomized trials and found that people attending our programs have less pain,  and less depression, are more active and utilize few health services than usual care controls. We now have more than a million people who have taken our community based or Internet based programs. These programs are usually free or low cost and in a few places are covered by third party insurers. 

With the endorsement of self-management by the National Pain Strategy -- what are the implications?

It means making changes for both patients and providers. For patients it means that they sometimes have to change the way they think about pain. We tend to think that when we are not feeling well, we can go to the doctor and get fixed. Unfortunately, for most people with pain this is not possible. For providers it means that they may have to think beyond the traditional treatments of medicine, surgery and physical therapy. Treatment for pain is not usually passive, it takes active participation of both provider and patient and the patient must learn the skills and gain the confidence to be an effective self-manager. This cannot be done in a few minutes.  Rather these are gained over time in a structured setting. For pain, self-management will continue to be a central part of pain management.

What does it mean for your work, and the work of your group?  

We will continue to spread our programs and hope to also develop an Internet based pain self-management program. We are in the best of all worlds for doing this. At Stanford we are part of the division of Rheumatology (arthritis) and also have an excellent working relationship with the Stanford Pain Management Center.

What’s the most exciting thing on your horizon at the moment?    

With the National Pain Strategy we stand ready to work with our pain partners to expand our programs and to forming new partnerships with health care providers. We will also release a Spanish pain self-management program later this year.

To find a program near you go to http://bit.ly/1R3xwwd. Look for the Pain self-management or the chronic disease self-management program. 

Read the final report of the National Pain Strategy here.

#3 Most-Read Article at Pain Medicine: Pain Psychology!

New rankings at Pain Medicine show that less than 2 months after its publication "Pain Psychology: A Global Needs Assessment and National Call to Action" is already in third place in the "Most-Read" rankings of the journal! These positive results underscore broad interest in the topic of pain psychology and its role in the treatment of pain, as well as interest in understanding issues regarding access and barriers to care. Therapists and psychologists in the U.S. need access to low-cost pain education opportunities, in order to facilitate patient access to pain psychology care. Current legislation in multiple states proposes to limit access to pharmacologic treatment for pain. Instead of simply removing care options we must optimize new treatment pathways. More than ever, we must develop programs and systems to facilitate access to high quality non-pharmacologic pain treatment, and align with the National Pain Strategy.

Download the open access article for free here.

Read more about pain psychology and the American Academy of Pain Medicine here.

3/24 Pain Psychology Twitter Chat hosted by Stanford - Join us! #PainPsychChat

Join myself, the American Pain Society (@AmericanPainSoc), the American Academy of Pain Management (@AAPainManage) and others at the Pain Psychology Twitter Chat hosted by the Stanford Division of Pain Medicine (@StanfordPain)! Bring your questions, your experience, and add your voice to the conversation. Come learn about the role of psychology in the experience of pain and in the treatment of pain.   

Follow @StanfordPain, @AmericanPainSoc and @AAPainManage and use the hashtag #painpsychchat to participate in the chat! 

Pain Psychology Boldly Takes A Seat At The Table

AN HISTORIC MOMENT FOR PAIN PSYCHOLOGY    

Pain Psychology made history this weekend at the annual meeting of the American Academy of Pain Medicine (AAPM) in Palm Springs, CA. The inaugural AAPM Pain Psychology Shared Interest Group (SIG) meeting took place with strong support from the AAPM leadership, including immediate past President Bill McCarberg, MD, and the 2016 AAPM President Dan Carr, MD. The Pain Psychology SIG is co-chaired by myself, Dr. Judith Scheman and Dr. Sean Mackey (Past President of AAPM). 

BROAD ACADEMY SUPPORT FOR PAIN PSYCHOLOGY

The initiation of the Pain Psychology SIG dovetails with the 2015 formation of the AAPM Pain Psychology Task Force and signals that the Academy embraces psychology and behavioral medicine, and is showing their support by providing us a place to call home. The Pain Psychology SIG provides the essential platform to begin efforts that will help address gaps in pain education and critical barriers to access for pain psychology services in the U.S.

PAIN PSYCHOLOGY NATIONAL NEEDS ASSESSMENT     

A few weeks ago I blogged about the findings from the AAPM Pain Psychology Task Force's national needs assessment for pain psychology services, resources and training. Roughly 2,000 individuals across 6 key stakeholder groups were surveyed by the task force, and their data are described in the report (free download here).

The report is boiled down thusly: We need better pain training for therapists and psychologists, and individuals with chronic pain need better access to high-quality pain psychology services and resources. This latter issues involves being able to locate qualified therapists and ensuring that insurance covers the services of qualified therapists. Right now, all of these issues stand as barriers to pain psychology care. In order to change the landscape of chronic pain treatment, we need solutions that involve education and policy changes. The AAPM Pain Psychology SIG provides the critical platform to begin this important work.

LEADERSHIP SUPPORT    

We were fortunate enough to be supported by the Editor-in-Chief of Pain Medicine, Dr. Rollin (Mac) Gallagher, who wrote an accompanying editorial that highlights the work of the AAPM Pain Psychology Task Force and the results of the national needs assessment. The editorial acknowledges the integral, bedrock role of psychology in the experience and treatment of pain and calls for greater inclusion of the discipline in the treatment field. (Read more here).

PAIN PSYCHOLOGY IN THE NEWS     

Lastly, pain psychology and the efforts of the AAPM Pain Psychology Task Force are hot topics! We received press from Clinical Pain Advisor and Psychiatry Advisor, both may be viewed here:

AAPM Task Force: Enhanced Pain Psychology Training Needed for Psychologists

Task Force: Pain Psychology Training Needed for Psychologists

It's an exciting time for psychology and the field of pain medicine. Stay tuned for further developments on pain psychology from within AAPM and beyond. Much more to come!

Pain Psychology: A Global Needs Assessment and National Call to Action

In late January 2016, Pain Medicine published the article "Pain Psychology: A Global Needs Assessment and National Call to Action." The article is available free of charge here

The article is a report of the national needs for pain psychology services, resources, and education across 6 key stakeholder groups in the U.S.: individuals with chronic pain, psychologist/therapists, pain physicians, primary care physicians and physician assistants, nurse practitioners, and directors of psychology graduate training programs. The study was spearheaded by the American Academy of Pain Medicine's Task Force on Pain Psychology (Co-Chairs: Beth Darnall, PhD; Judith Scheman, PhD; and Sean Mackey, MD, PhD). The study involved administering brief surveys to individuals across the 6 stakeholder groups. Almost 2,000 responses were received.

The results speak to the dearth of current pain psychology resources available to individuals with chronic pain. While the United States is amidst a pain crisis and the so-called 'opioid crisis', current pain psychology resources are inadequate, and even psychologists and therapists feel ill-prepared to deal directly-- and to treat-- chronic pain.

It is clear that dealing with both crises will require increased efforts to effectively train generalist therapists with basic pain education, and to train others to be pain psychology specialists. Read the full article to learn more about what we feel is needed-- as a national first step-- to improve access to pain psychology, and to treat the full definition of pain. With 100 million Americans living with some degree of pain, bold actions are necessary to shift the current trajectory and improve the quality of life of millions.