AAPM: National Need for Chronic Pain Psychology Services

AAPM: National Need for Chronic Pain Psychology Services

By Ed Coghlan

Dr. Beth Darnall

Dr. Beth Darnall

Beth Darnall PhD is Clinical Associate Professor in the Division of Pain Medicine at Stanford University and treats individuals and groups at the Stanford Pain Management Center. She has been a leading voice in arguing for the importance of more access to pain psychology services for the nation’s large chronic pain population.

She is chair of the American Academy of Pain Medicine Task Force on Pain Psychology and late last year asked the National Pain Report’s help in getting pain patient reaction to a survey. (Here’s the story)

She shared some insights from the survey.

“Our national needs assessment on pain psychology services, resources and education was conducted in response to the IOM report and the draft National Pain Strategy.  Both documents call for better training in pain across disciplines of care, including psychology.  Our surveys of individuals with chronic pain identified gaps in access and barriers to pain psychology services.  We also report of gaps in training in pain amongst psychologists and therapists.  Physicians are taught to treat pain from the biopsychosocial perspective, and yet they are not given access to the providers – qualified and competent pain psychologists—who can treat pain.  We need concerted pain education in psychology programs from the undergraduate, graduate, and post-graduate levels.”

Pain Medicine just 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.”

Beth Darnall is lead author on the report. She is Co-Chair of the Pain Psychology Task Force at the American Academy of Pain Medicine. Here is a link to her website.

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@BethDarnall

Authored by: Ed Coghlan

There are 13 comments for this article
  1. Dr. Clinton Smith at 7:08 am

    The American Medical Association approve clinical hypnotherapy in 1958 for pain control. For a number of years I have assisted people to reduce and eliminate all types of pain. The treatments can be delivered without the use of the word hypnosis or psychology. Both unfortunately are seen by many as a stigma. Consider if there is pain in the back, knees and shoulder the pill goes to the brain. There are numerous psychological techniques that alleviate pain.

  2. MICHAEL WAGNER at 7:33 pm

    I HAVE READ ALOT LATELY ON PAIN, I SEE THAT MANY UNIVERSITYS ARE COMING UP WITH NEW PAIN MEDICINES, THEY STATE THEY HAVE TESTED THERE PAIN MEDICINE ON RATS, I WOULD LIKE TO SAY I HAVE HAD RECENTLY A DNA TEST AND MY DNA IS ALOT DIFFERENT THAN RATS.
    WE NEED BETTER TESTING THAN RATS.

    SINCERELY,

    MICHAEL WAGNER

  3. HJ at 8:27 am

    Dr. Terri Lewis…

    Very important and critical points!!!

    I’d like to add that mental health diagnoses and care DELAYED the recognition that I really HAVE chronic pain (widespread osteoarthritis, possibly fibromyalgia) and when I asked for a sleep study, I was told that I was “just depressed” and had anti-depressants shoved at me. A few years later, when fatigue got worse and worse, I finally had a sleep study. I have obstructive sleep apnea.

    I went through hell. I don’t say that lightly.

    For at least seven years, I had no pain management. I was so exhausted that my cognition and memory were impacted. I came home from work and slept until the next morning and woke up feeling like I’d been hit by a truck… then did it again the next day. I re-gained all 175lbs that I’d managed to lose before I started to feel ill. Now I weigh just over 300lbs… again. I told the doctors I was too tired to plan and prepare meals and exercise.

    I was “just depressed.”

    Sometimes psychology is more of a hinderance… a disaster, really… a freaking train wreck… than a help.

    That said, I had a cognitive behavioral therapist who helped me set goals, who helped me deal with doctors as an advocate, who talked to me about dealing with co-workers and employment when I have chronic pain and who recognized that yes, I was dysthymic but who wouldn’t be with the complex health issues I have. But I was never “just depressed” and I probably would have been better off if my chronic pain and chronic fatigue had been addressed all those years ago by doctors I came to in TRUST for help.

  4. HJ at 8:12 am

    The pain clinic that I visited years ago wanted me to come 3 times a week, spend 3-4 hours each visit. Is this for people who don’t work? My job wouldn’t let me have that kind of time off.

    Nevermind that now that insurance costs have skyrocketed, there’s NO way I could pay a $60 copay per visit, 3 times a week for how many weeks. Want to give me injections? I have a $2,000 copay.

    There are too many barriers to getting help anymore. No wonder people in pain are also depressed. As if chronic pain and the fatigue that often comes along with it isn’t enough to deal with.

    Frankly, it makes me angry to hear that more specialist care is needed when I can’t afford it and when, in my experience, it doesn’t make allowances for someone who is fortunate enough to still be working. At the time, I asked their office for flexibility… and no. It was this treatment program… or nothing.

    It re-awakens my anger and my grief to even get near the topic. Be careful how you go about “helping” us. Focus your efforts on the outrageous costs of insurance premiums and deductibles instead. A lot of us can’t work anymore, and those of us who are working and have insurance can’t afford you.

  5. Kristine (Krissy) at 7:17 pm

    I also went to a clinic that had the whole works…pain doc, psych and PT. After my third visit to the psych, he had kept me waiting for 1.5 hours and as I went up to the receptionist to tell her I had to leave (I was angry!), he popped out and put me in his office and said, “What brings you here today?” I cocked my head like a puppy, with my stupid homework in my hands, and realized he thought I was a new patient. I never went back. I have actually never gone back to a doctor who doesn’t read my chart or knows who I am and my medical history. No more psychologists or psychiatrists for me. I am 63 and I can write the book about myself now.

  6. Donna at 11:43 am

    I think interdisciplinary treatment is important. The difficulty is finding the individuals to form the team. I am less than impressed with just about any physician, medical or psychiatric. And then try and get them to collaborate? There is a clinic where I live that has this, but insurance doesn’t cover the entire practice. Doesn’t make sense to me. I would think that in the long term it would actually save the insurance companies money if patients got good care from the beginning, but I guess they count on us to give up.

  7. Kristine (Krissy) at 9:00 pm

    I agree with Dr. Darnall that this is a problem, yet I have my own stories where using psychologists have been less than helpful. Yet I want to make a couple of different points here.

    1) It is an obvious fact that there is a large difference in the levels of care patients have available to them based upon location. A big city will have more docs from which to choose versus a small, rural township. It doesn’t mean the talent of the docs are so different, but it does often mean the difference between the luxury of having a “doc-for-all needs” and a pool of specialists.

    2) There are many elements of living with chronic pain that need psychology and the help it can provide. I believe it takes a very talented psychologist to get to know a patient well enough so the patient is comfortable listening and participating in his/her treatment plan to ensure it is effective and ongoing.

    3) The availability of insurance coverage has gone from zero to good coverage, and back to almost zero again over the years. We as patients are often taxed beyond our means just to pay the PM and fill the Rx.

    4) There is a fine line between the type of psychological care a patient gets and what the doctor’s opinions are as they relate to diagnoses. Some psychologists will read depression as an isolated diagnosis that may be coming from someone’s past, and if the patient is not communicative about what pain disease has caused them to experience, the relationship between diagnoses could get confused.

    My doc is a PM specialist as well as a neurologist, neurosurgeon and psychiatrist. I live in a wealthy city (I don’t really fit in anymore:)) and the care here is outstanding. I hear from friends who aren’t so lucky. I do think psychology plays an important role. We suffer with enough pain that it is bound to affect our brains. We suffer with enough stigma that it is bound to affect our psyche, and we suffer with enough isolation that we are bound to need an intelligent conversation now and then with someone professional who can “dig in and help out.”

  8. Dave at 5:46 am

    Im all for people having access to the services and treatments of their chosing to address pain. I understand, that Dr Sarno has had success helping many with pain using a psychological approach- as has Gerd Hamer with German New medicine- and its variants- Advanced Clearing Energetics, Meta- Medicine. In addition, I have read about some being cured from chronic pain using meditation or psychological approach.
    Having said that, I think pain specialty organizations and the powers that be wish to managerialize and institutionalize all pain care in their image. They do not favor people in pain having the freedom to chose whatever treatments they wish. They have made up their mind that no one in pain should have access to curative treatment- as their focus is creating the “lifetime pain patient”. They are biased toward CBT or ACT- you know the “evidence based” stuff- and frankly as they haven’t done much exploring of alternatives- they wish to limit people in pain to the treatments they know-and most of that is from the 1980’s.
    This article is a wolf in sheeps clothing- the author may believe in access to pain psychologists- but only those that her and her pain specialty organization approve of. They do not believe in freedom of choice in pain care.

  9. Kerry McKelvey at 7:54 pm

    Maslow’s Theory “Hierarchy Of Needs” dictates you have to effectively manage the pain before the patient can even get out of bed to get to their appointments and under treating pain over more than a short amount of time is close but no cigar. The length of time with not enough pain relief causes serious hormonal and cognitive impairment. I know good support and pain management strategies help but I know medical doctors aren’t learning how to be good pain doctors in med school, in fact based on the two I know of that were/are teaching who helped write the CDC guidelines and the lack of advocacy in the pain field as a whole except for a few courageous and awesome heroes, we are in serious trouble in this nation and failing a big chunk of our best and brightest. We MUST untangle the addiction/dependence definitions as the very first issue before we target this or I know we will just have a bunch angry pain patients going absolutely nuts if they have some idiot suggest their problem is addiction, and rightfully so! This country is exponentially going backwards with every ignorant media comment or movie we see the cowboy crush up a hydrocodone and snorting it after getting treated for a broken bone treated or a row of politicians standing up holding hands promising veterans they are sworn to be protected by them from being treated with addiction causing medications! Even the ignorance that addicts have to go without pain treatment. We better get a clue and be going in the right direction in pain treatment with and without opioids and stop thinking there will be any acceptable way of eliminating opioids period for everybody all the time until science has an alternative that works. Not saying this work wont or can’t help some stop their opioid prescription but to even suggest it’s THE answer for all pain patients all the time and telling them “they better just learn how to deal with their pain” your not getting any opioids because others have addiction is the exact same as telling diabetics they better give up their insulin because their neighbor is consuming too much sugar. Opioids save lives too and are required for many pain patients to have a life without an immense amount of suffering and a lot of people have no idea it’s a neighbor or family member that’s suffering right now in ways they can never imagine because we as a country are fixated it’s going to solve a problem that’s being created for political reasons sadly enough. Just look at and ask what is being done about alcohol and the destruction it causes and it has no medical application at all!

  10. Donna at 2:28 pm

    I’m not sure how I feel about this. As we are already a group having difficulty getting medical help (as the article states medical students get little or no pain treatment experience), I would be afraid that this would make it even more likely to be overlooked as a medical patient and be directed straight to a mental health professional. This means we are more likely to have missed diagnoses and be given dangerous psychiatric meds.
    On the other hand, I think if treatment centered coping behaviors and non-pharmaceutical interventions, then I think that would be beneficial. Of course, insurance comes into play as well. Mental health services are very expensive and having insurance doesn’t mean it will be affordable (at least not in my case).

  11. Terri Lewis PhD at 2:27 pm

    As a former agency director, and now academic/social scientist, I can personally attest to the fact that nowhere is our system of personnel preparation are we paying attention to the necessity of serving the needs of chronic illness – much less chronic pain. We don’t do it in general medical education, which leads to delayed prevention and intervention and unncessary specialization. We don’t do it in mental health, which means that when a person with chronic illness is referred they are treated through the model of mental illness – if they aren’t mentally ill to start they will be when we get done with them, We don’t do it in addiction services, which means that persons who present receive their services delivered through the addiction model. We don’t do it in the field of vocational rehabilitation, which is predicated on a return to community vocational roles even when we know this is unacheivable. We don’t do it in the field of social work, either. Our population characteristics are shifting. By 2029 one half of the population in the USA will be 65 making us what is known as a superaged population – with all that goes with it, including chronic illness. To deny this fact in our health care system design is NUTS!

    We need to identify this creature referred to as the biopsychosocial model of care, and arm it with a practice identity that incorporates and integrates a person’s needs with the demands of their environment to optimize function across their lifespan. It’s not rocket science. We need less specialization, more optimization and integration, and most importantly adaptation of our professional practices to meet the needs of people, not ‘cases.’

    Beth Darnell, thank you for this discussion. Count me in.

  12. Elizabeth Harris at 2:20 pm

    My frustration level with the state of chronic pain care just rises daily. I am not one who would abuse my meds. I don’t need money, so I won’t sell them, etc. I had a pain pump, but if human error caused an interruption in delivery, I would go into a horrible withdrawal. Therefore, I weaned off the pump. I now take hydrocodon 10 with ibuprofen for extra help. I do not have any problems with addiction any longer. I have not had a pain free day for 20 years or more. Yet, I live with increased oversight to get the meds I need. Reading about the psychology of helping pain patients, just adds more frustration. I can not imagine how counseling would help my pain. I had a year of counseling when my husband died at 50. It helped tremendously. But how can counseling help my pain? The power of positive thinking? I’ve learned to do that. Bio feed back? Perhaps, but none of the psychology techniques can do anything to take my pain away. If I let myself feel sorry for myself or get angry that I have to live with it, I might go crazy, but I don’t allow myself to go there. I need easier access to my meds, I need medication that does not cause addiction, I need something that will control the pain to the point that I can return to a normal life. What can psychology do for that? By the way, I have an extreme case of fibromyalgia. I am extremely limited in what I can do. I was completely bed ridden for 5 years, so I have improved. My family rejoices when I can go grocery shopping, do laundry, wrap Christmas presents, etc. If i do anymore things on that level, I will be bed ridden for a couple of weeks. I also have a disc problem in my lower back. My pain Doctor only concerns himself with that. I have to see him once a month just to get my meds refilled. Pain patients don’t need to make an exhausting trip to the dr. more often, they need to go less often. The medical world has gotten so paranoid about pain meds, that they are hurting us more. I need more research done on the right areas. I need more help.

  13. Bonita Shockley at 1:08 pm

    My pain psychologist has saved my life. I see him every time I see the pain doctor. I would have lost my mind a long time ago if I had not had help from my pain psychologist.