Opinion: Twitter Chat on Chronic Pain a Success and a Good Start!

Opinion: Twitter Chat on Chronic Pain a Success and a Good Start!

By Geralyn Datz, Ph.D.

Dr. Geralyn Datz

Dr. Geralyn Datz

Geralyn Datz, Ph.D., is a licensed clinical psychologist who specializes in behavioral medicine and is the current President of the influential Southern Pain Society. She participated in last week’s Twitter Chat on psychology and chronic pain. She shares her observations.

I thought the pain psych chat from Stanford Pain was a marvelous idea.

When people hear “pain psychology” it seems to make intuitive sense, but it’s very hard to bridge the gap between medicine and mental health today.   This is because we are still very dualistic in our thinking.

Part of us understands that the mind affects the body, and the body affects the mind. But another part of us, and I mean the collective us as in healthcare, and us as individuals, just want our suffering to go away. It is very hard to take responsibility, self-manage symptoms, look inward, and even just accept things that are unwanted and poorly timed, like an injury or getting a disease.

Thanks to social media, it’s easier to raise awareness of the importance of the Mind Body Connection, and the connection of pain psychology to pain management in particular. Venues like Twitter and Facebook allow us to take down our titles, come out of our typical work space and setting, and start a conversation, in snippets, about the things we consider most important. That really cuts through a lot of administrative, medical, and professional red tape, so to speak. We just have our thoughts and people can simply agree or disagree.

The “opioid story”—rising death toll, addiction rates and just the general lack of getting better while people are on these medications and the recent CDC guideline—has dominated both media reports and discussions about pain management.

It has created an opportunity to have a discussion about raising awareness of other treatments for chronic pain, like pain psychology and non-prescription treatments.

When I treat patients, I understand that lack of movement, depression, lack of sleep, losing one’s place in the world, losing self-esteem, losing work, are all very unhealthy. Healthcare providers know these things. There is also a large quantity of research supporting work and valued activities as having a very strong relationship to physical and mental health. The part that’s not intuitive for providers, is how to accomplish this treatment. There are barriers including insurance and lack of knowledge of how to refer and who to refer to.

Pain patients are often so relieved when they hear that it’s normal to have depression, for example. But that same depression has health problems associated with it, that lack of sleep and lack of movement just makes a body break down. I think this is all very understandable to a patient with pain.

What is a harder sell is the idea of change: Changing behaviors, changing attitudes, changing thinking.

Unfortunately, many, but not all, surgical and interventional providers have a singular mindset on how to relieve pain, in their case, with surgery or injections. While these treatments can be helpful in certain instances, they are vastly overused.

What’s the patient to do? It is very hard for a patient, with or without a pain psychologist, to stand up and say, “Hey, I don’t want this or that treatment, I want to try something else.”

Maybe it’s exercising more, eating more healthfully, or learning how to control thinking and emotions. Maybe it’s finding a new healthcare provider that offers treatments that have not been discussed. All of these actions involve an internal shift on the part of the patient, which is very hard, and almost impossible without guidance from an experienced professional.

And then there is the time it will take to learn these treatments.

And then there’s the cost.

Some things aren’t reimbursed (like joining a gym or extra physical therapy visits outside of what your insurance covers).

It can be frustrating.

What the heck are we going to do?

The Twitter chat started a dialogue. I loved seeing the participation from patients, providers, and physical therapists, and thought leaders. That is very encouraging. It’s important for patients to know that chronic pain affects the brain, hormone function and generally disrupts our biological systems. The thing that we are just learning to grasp is that a lot of this can be reversed. Even the effects of chronic opioid therapy can be reversed under the proper circumstances. And this is where the coordination of mental health, activity, healthy behaviors, and laying down new neural pathways is so vital in pain rehabilitation.

Some chronic pain patients, especially those who have been suffering for a long time, are skeptical. I understand that.

One of the most exciting things we see in our Clinic, is how our functional restoration program can get a patient in who’s even 10 or 15 years post injury and you see them moving, walking and even running. It’s not magic. It only happens through a very tailored multidisciplinary intervention with patients with pain. It takes an enormous amount of coordination and unlearning of old habits to produce dramatic changes. But I am here to tell you it is possible and we see it every day.

We need to keep talking as a pain community. The Twitter chat was a great start.

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Authored by: Geralyn Datz, Ph.D.

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I am SURE there are plenty of attorneys living with chronic pain who would be willing to take part in a MASSIVE lawsuits against ALL agencies involved in the violation of our rights.
Who are they? How do we, as a community in pain, find them and who can organize this? I know that is a long term potential solution as lawsuits can and do take years when dealing with governmental agencies. However, that will cause the media to take a bigger look, hopefully. As we all know, if the people on the news say it, it must be true.
I believe that is one of the biggest things that can be and should be done. CNN, FOX news, MSNBC…ALL I have heard is “opiod addiction”. I have NOT ONCE heard “chronic pain”. There is a gross misrepresentation not only in the news but in these governmental committees. I watched one the other night and the questions asked by the Senator heading it let it be well known he so oblivious to what is going on. He didn’t even know the right questions to ask. And, there was NOT ONE doctor or ANYONE there standing up FOR patients. EVERYONE of them solely spoke AGAINST opiods for chronic pain. Period. I know all of you know what I am talking about here.
So, I say, someone needs to organize a time and place for pain patients to show up and tell their side to the government to give them the TRUTH before it’s too late. These bills and types of legislation is being voted on and PASSED with amazing speed!
We cannot wait or it will be too late!
Please! Who, what, where, when do we show up? If I had influence or headed a networking of thousands of patients, doctors and advocates, I would. But, I don’t. I am a participate and I am READY AND WILLING TO FIGHT THEM ON THEIR TURF!
I know one of you can organize this or know someone who can…


Krissy, Thank you for your comments. I am torn about which way to turn. I have been to so many doctors that I can’t recall all of them. Some are dead, some moved, and some are retired.And I have moved a few times also. Some I was dismissed from because they didn’t know what to do with me. Some started me on multiple pain meds at once, then after a few months dismissed me because they were basicly afraid that they would lose thier license. I only ask for relief. I didn’t expect miracles. Not then. But now so many have been sick for so long that YES!! I do ask for a miracle ! It has gone on to long. Too many other diseases have been helped, if not stopped or cured!
I know some people still don’t believe fms/cfs or chronic pain is a real problem. I also know of doctors that tell thier acquaintances that it is a fake disease, “woman get after they have been out shopping too long and come home sore and achey ! Yes, a nurse told my daughter that her doctors,her (employers) said those exact words to her , many times. And they all have a good laugh about it. And I honestly think my daughter believes thator at least is torn about what to believe. It makes me so sad.
Anyway, there needs to be someone who can say , give us relief until an acual cure is found. It seems criminal to withhold relief from anyone in pain. I only take tramadol. At least they could continue that !
Thank you for listening and I wish you luck in your problems and I will pray for you also.

Dr Oberg, thanks for the acknowledgement. If it proves to be constructive for you to assemble patient testimony in the issues raised by the recent CDC and FDA policy changes on opioids in chronic pain, I can put you in touch with at least hundreds if not thousands of people affected (obviously, in addition to those who post here on the National Pain Report). I daily support and interact with 10 Facebook groups focused on chronic neurological face pain patients, family members, and physicians. Aggregate membership in these groups is well over 10,000.

I can be reached by email through my personal website at http://www.lawhern.org, “Giving Something Back”

Regards and again, thanks.


Brenda, I just wanted to say that your story saddened me and you will be in my thoughts and prayers. Keep good documentation of what goes on with your doctors. It doesn’t hurt to video him/her at your next appointment. Once I went back to my doc after he didn’t give me strong meds and said I couldn’t stand the pain, can’t sleep… He then gave me meds. But it sounds like you need a new one. I hope you can find a good PM DOC.

Richard Oberg M.D.

Dr. Lawhern – fantastic work and comments – many many thanks. I’ll be referencing your work in future discussions.

We just had our first full afternoon sit-down interview with a reporter from a statewide media outlet – for us let the games begin! A fantastic experienced interviewer and I could only hope future similar events would be done by someone so good. Will keep everyone posted as events develop.


If one in three commit suicide and there is no changing the minds of the gov.agency’s that have made these rulings, then at least we ( people in pain) will not be bothering the docs for meds anylonger and crowding their waiting rooms. Because if I don’t go to the doc for pain meds then I won’t be going at all, because there are no other treatments for fms/cfs, and I think I will refuse any more back surgeries. I have had 3. There are no pills for anything I have except shingles.And sleep problems, and then there is only one pill that has slowed the breakouts down and they prescribe it 12 months at a time. I have had shingles often since 1970. Very painful.
And sleep? It has eluded me since birth. I have unconsciouly fought sleep since birth. Tried evertying.relaxation cds, benedryl, so many pills And other therapies. But Ambien has been my saving grace. Now he even wants to take that away. How tragic.
Is this just a way to “thin the herd ?
I wish my doc would fight for me like you all are . His response was, no more pain meds because he is “covering his butt”. Well now, that made me feel better…. I ask him what about me and the other people in pain and he said we would all have to learn to do without pain meds. Period.
So thank you all for fighting for us pain patients. I will do anything in my power to help. !!! Just remember I have MONO now and am spending my days in bed or on the couch, the chronic fatigue is winning. This is the 4th documented time for me. Hopfully it will be over soon, now in the 3rd month.
Please keep fighting for us….
Btw, I have tried all the treatments that have been ask of me. I also went off pain meds years ago for a year. I wanted to die. I tried p.t., bio feedback, all vitamins and supplements, and at one time they had me on 2 mood elavators, muscle relaxer, presc. anti inflamatory and more, psychiatrist, thearapist and more, much more. None helped. Like So many others have spent a fortune on treatments and meds that didn’t help…We even lost our home because of expensive treatments, travel and meds.
So for anyone who helps ,Thank You . And if anyone knows of a good doc in the north Alabama or southern TN area,,would you please let me know. Please. lizzilou2001@yahoo.com

Dr. Datz, you have been careful in your wording and I believe that you intend to be constructive. However there are important elements missing from your sincere attempt at conversation. It is time and past time for the term “psychogenic pain” to disappear from the medical vocabulary. And this is true even if we recognize a mind-body connection that may be useful to employ in managing pain for some patients. Reality is that by the simple act of assigning a diagnosis of “psychogenic pain”, or “somatization”, a medical doctor will reliably increase the risk of suicide in their patients by 250%. This observation is supported by recent published work from a research team at the US Veterans Administration, who studied suicide risk associated with seven non-cancer diagnoses in the records of nearly five million patients followed for three years. By assigning these diagnoses, the physician renders it almost impossible for the patient to be regarded seriously or supported by further medical testing and treatment trials. Thus the plausible mechanism by which suicide risk is increased is simple isolation and despair. I explain and expand on the VA research in an article published on the Global Summit for Diagnostic Alternatives, of the Society for Humanistic Psychology: http://dxsummit.org/archives/1002 It is also time for the American Psychiatric Association to be forced by lawsuit to withdraw its related mythological diagnosis called “Somatic Symptom Disorder” from the DSM-5. Although it is clear that depression can aggravate physical pain by causing sleep disturbance and physical exhaustion, there is simply no body of validated medical evidence to support the silly notion that depression causes physical pain, absent some other medical cause. As no less a figure than Dr. Allen Frances (Chair of the APA DSM-IV working groups) writes in his blog on Psychology Today, a diagnosis of SSD is frequently equivalent to a declaration that the patient’s symptoms are “all in your head” with the implication that you can get better if you’ll only change your attitude. That almost never works. And while patients are chasing this mythology, they are vulnerable to progression in underlying physical disorders that the physician has missed or misinterpreted. Patient deaths have *already* occurred from such medical mistakes. Finally, I believe that the application of psychological techniques to chronic pain needs to be much more nuanced than current practice typically facilitates. Some patients are effectively coerced into frameworks like Cognitive Behavior Therapy by being told that they won’t be treated medically until they engage with therapy. The medical evidence for CBT itself is seriously weak when applied to chronic pain conditions. To have a conversation, we must listen to each other. Despite their supposed training, it can be hard for psychologists to hear their clients when the message threatens their financial well being by challenging the validity of their assumptions. I respect this difficulty. But I never the less encourage you to embrace the process.


I got the same letter from the President. I bet a bunch of us has. Ridiculous!


Count me in as the third musketeer- becker.david2@gmail.com

Michael Wagner

you people that are trying to get through to the FDA and other go to agency’s
Try Dr Forest Tennant as he seems to have a way in with those people, I think most of you know of him. If not he a web site Foresttennant.com and is on the web site for pain specialists http://www.practicalpainmanagement .
Hope this helps as DR Tennant is very aggressive on pain control and I know he is upset with the way they have been handling this, with very unqualified people, that should not be treating patients in pain

Michael Wagner

Richard Oberg M.D.

Dave – thanks so much. If there’s any way we can coordinate our efforts for maximum impact feel free to use our names (as many may have guessed my wife is Holly Clowers M.D.) if it helps your presentation. We’re going forward full speed with full disclosure and let the chips fall where they may – we have reason, the other side’s own bad data, and our own story of abysmal discontinuation of care here in TN. due to bureaucrats disguised as ‘physician experts’ which we are too. My wife’s tried a broader appeal that has failed so we’re ratcheting up things a few notches more into my very direct approach I’ve mostly favored.

BTW- she contacted the president with a very direct letter about ‘our’ side and got back a political form letter missing the point entirely with ‘we’re glad you’re with the president in curbing opioid abuse….’ if only he knew. Hope you do better. I can’t imagine the president liking the fact that he’s been bamboozled by addictionologists and their federal mouthpiece via the CDC but obviously have no idea and these people are completely insulated from the real world. I’d like to believe if he knew what was really going on he’d be furious. I tried but couldn’t get anyone to respond at the FDA I thought would appreciate someone actually backing them up against other fed agencies coalescing against them. Perhaps too soon to know we’re credible witnesses but they’re going to find out.

Best of luck Dave and let’s share results and keep in contact. I want folks here to know there are people taking this fight forward and we need all the help we can get.


Dave and Dr. Oberg: Count me in.



Dr. Oberg- I have contacted my Senator and his staff has agreed to address my concerns with democratic accountability at the CDC and NIH regarding my efforts to comment on the NPS and the opioid guidelines. And certainly I will share whatever response the Senator receives- whether it is no response or a boilerplate response from the aforementioned. Of course, soon enough I will write to the President, as well regarding democratic concerns. In addition, I will write to other governing bodies.
If I can be of assistance with your concerns- let me know. Id be willing to make a phone call or write a letter on your behalf. By working together, we have an opportunity to change the anti-democratic homogenization of pain care.

Richard Oberg M.D.

I hope good for all of us Krissy. No one will get past us with any false statistics – in fact, debunking most of what’s going on will be painfully (no pun intended) simple and we have literally piles of supporting literature. I do best with an audience whether one or a room full of 100 physicians – it’s impossible to engage in any meaningful discussion about any of this without some face to face. There’s so much already out in print by highly intelligent folks such as Dave, Terri Lewis, Bob Twillman, and others yet the media continues its outpouring of the same stale (and wrong) CDC misinformation disseminated through endless echo chambers. In two years I’ve yet to hear a single supportive major media statement with any traction about the widespread loss of opioid pain med relief to the majority of patients who benefit with track records of compliance and relief. Addiction related issues have sucked all the oxygen out of the discussion. Now, without any input from patients like all of us, they’re going to just take it all away – I refuse to accept it without a fight. The AMA just released a notice of new medical student curricula based on the ‘new CDC guidelines’. Knowing things will get worse before they get better is painful indeed.


Dr. Oberg, good for you! I hope they write in our favor and don’t look up stats that wll turn out to be wrong! Arm yourself and let us know in a story.

Richard Oberg M.D.

These comments are correct and my wife and I have had it and are taking our side of the story to multiple media outlets and see if there’s any chance to change the nonsense about opioids and stop the lazy sycophants including the White House who’ve become an echo chamber quoting and re-quoting the same absurdities resulting in immense patient harm we’re all familiar with. There appear to be some reporters from both state and national reporting sources interested and I’ve compiled a damning story of statistical lies and serious conflict of interests which should raise any number of eyebrows – we’ll see. We meet with a reporter next week – wish us luck. Some reporters have been paying attention and perhaps been waiting for something credible to contradict the nonsense – let’s all hope so.

It is Time To Take Legal
Action For Patients.Their Are More Than Enough Patients,I am Sure That We Would Donate More Than Enough Funds To All Organization’s To Stop This Inhumane Act.FIGHT For Our RIGHTS.Do The Right Thing.Your Name Will Never Be Forgotten,Never.Who Will It Be? People are waiting in GREAT PAIN.

Chrystal augustyniak

I’ve been sick for 11 years and only 3 of those years have I turned to pain meds, 8 years trying absolutely everything I could for pain relief and not one thing helped me, I changed my diet, took many vitamins, talked out my problems which I don’t have any, I’m very happily married and he has been my rock 3 amazing kids, lovely home, lovely life style, 8 years of pure hell even worked while sick that’s when I had 3 accidents, I fell down the stairs twice and had a bad accident at work all because of fibromyalgia an unseen, undetected, until cared for, unempathic, uncaring, relentless illness which everyone has a theory but no proven facts about what fibromyalgia really is which makes my life a living hell.. I only turned to pain medication with the counsel of my family because of my back issues but before my back I did everything I could to stay on a holistic path which including… Acupuncture, heat and cold therapy, physical therapy, ibuprofen, eating right, NO JUNK FOOD WHAT SO EVER, and staying active.. All that did was make me feel even worse the next day, the more I did the worse the pain got bit I stayed focus on that path until I got hurt due to FIBRO FOG and yes that is very real where it feels as if your head is literally in fog but its in my head… The war on drugs is being taken way to far and those that suffer will commit suicide as it is 1 in 3 commit suicide that number will skyrocket but yet those numbers do not matter… Doctors of all kinds are cold, heartless and how most can sleep at night KNOWING THAT THEY ARE PLAYING GAMES WITH PEOPLES LIVES is beyond me…


Dave and others: I know we all express opinions here; that’s what comments are for. And it’s a great way to beef, isn’t it?! My comment, “Well said,” goes to the author. After 34 years, I’ve had a few providers. (I don’t know your age, but you may have as well.) When I started with pain for RA, I went to two Rheumatologists. One of them sent me packing after about 4 minutes and literally said, “You’re too pretty to be sick.” No blood tests…nothing. He was one of the bad guys. His wife was his office manager, so as I passed by her desk on my way out — in tears — I told her not to dare send me a bill. She didn’t. (In those days you had to send your bills to your insurance on your own.) I had been a model before I started my ad agency, and I’d pretty much had enough of mens’ gritty comments. (No offense guys, but it was bad in those days.) Things have changed…a lot. The other doc just didn’t believe I had pain…again, no tests. I am now 63 and have refused to ever go to a Rheumatologist since then, much to the chagrin of my other docs. There are plenty more stories, but I can’t blame doctors in general for the problems we are all experiencing. My mother once said, a person needs to be his/her own doctor. That sure turned out to be a profound statement. I now have an amazing pain doctor who truly cares, checks my mood for any bad depression (a history for me) and prescribes opioids. He is a good man and comes from a long line of doctors in his family here in Naples. He has no plans to change my meds. The problems we all have are coming from various sources, for various reasons, and every case is different — all while we share a large number of common issues. And you know that. It works both ways, too, as docs put up with difficult patients and many, many feel badly that they can’t make us well. This whole thing is a big subject! There are too many fingers in the pies of the government and as we all know, and by following along with the CDC and the other organizations against proper care and medication, and being or “acting” blind about the heroin and death statistics, the government and their special characters on the outside have left us the losers. I respect anyone who has something to say — but generalizing and blaming providers as being the problem isn’t enough. It doesn’t cover all that needs to be fixed. I do wish and hope that more doctors will somehow band together and fight for us and for themselves, but many of them are probably disenfranchised by having government step in and crush their plans and what they (most?) know to be the truth. It’s a shakeout, and while we feel… Read more »

Alvin Hill

” … rising death toll, addiction rates and just the general lack of getting better while people are on these medications … ”
I still can’t get over the use of this statement. Consider the “rising death toll” due to opioid overdose Let’s be more precise. The incidence of fatal overdose with opioids is comparable to that for firearms or motor vehicle accidents, and it’s smaller than the number of deaths due to trauma in young adults. It’s actually dwarfed by the rate of iatrogenic fatalities in hospitals and the rate of smoking related fatalities in the general public. The incidence of death due to insulin overdose is also large and increasing, as the diagnosis of diabetes becomes more common. A significant number of insulin overdoses are deliberate acts of suicide. Do we hear public officials warn of an “insulin overdose epidemic” or calls for draconian restrictions on insulin prescriptions? Why not? Insulin shares many characteristics with the opioids. It has significant, potentially fatal side effects. Patients with diabetes depend on insulin to maintain their quality of life. They display drug tolerance (called “insulin resistance”) that requires them to use increasing amounts of the drug to achieve a therapeutic result. However they are rarely, if ever stigmatized as “addicts”. The DEA deliberately conflates “dependence” and “tolerance” with “addiction”, but only when referring to the opioids. This may be because opioids are “naughty” in that they supposedly produce euphoria, while insulin does not. Of course, when opioids are specifically and appropriately targeted at pain, true addiction is exceedingly rare, which the anti-opioid fanatics conveniently ignore.
My point is this: the campaign to demonize opioid medications is in full swing and misinformation is the weapon of choice. We need to be scrupulous in our own use of language and in our reliance on demonstrated fact. We should also require that those who purport to speak for us are just as careful. For people who rely on opioid medications to combat debilitating chronic pain, especially when other forms of therapy have proved to be ineffective, this is a matter of dire necessity.

Alvin Hill

” … rising death toll, addiction rates and just the general lack of getting better while people are on these medications … ”

Motivated largely by ideology, influential factions within the CDC, DEA, and other governmental agencies seek to restrict or outlaw the use of opioid medications to treat chronic pain. In order to achieve their goals they are willing to distort and misrepresent the facts and to use blatant propaganda techniques to influence public opinion. I find it rather shocking therefore to recognize their misleading language in this kind of posting.

Opioids are not a panacea for chronic pain, but few, if any medications help every patient, regardless of the drug involved or the medical problem being treated. This basic truism is a far cry from the mischaracterization I just quoted. I dare say that the psychological interventions that Dr. Datz promotes do not benefit every pain patient and indeed may be less effective overall than treatment with opioids. However I’m not at all interested in such an unproductive contest of ideas. Chronic pain should be treated with whatever technique proves to be most effective for each individual patient. If opioids provide safe and effective relief for one out of a hundred – or one out of a thousand – pain sufferers, then those patients should be able to avail themselves of it without persecution. The same applies to psychological therapy too.

I suspect that the success rate of opioid therapy for severe chronic pain is actually considerably higher than one out of a hundred, but that’s irrelevant To demonize people or the health care providers who seek to help them, on the basis of ideology, using vague, unsubstantiated generalizations, is shameful demagoguery. To restrict or outlaw an entire class of medications for the same self-serving motivations is the antithesis of humane medical practice .




Perfect response


Change is a four letter word in the health care industry when it comes to people in pain. For providers still wish to impose their values, their beliefs, their underpowered treatments onto people in pain- without the advice of the person in pain. Providers wont change their position that people in pain should be passive passengers in their care. Providers refuse to provide much more evolved care. Providers are unwilling to make a real effort for people in pain. They wish to continue to impose unsuccessful and costly programs that have done all too little for people in pain.
This article reflects the fact that providers do not wish to acknowledge their role in contributing to the mental, emotional and physical problems of people in pain.
We know that providers contribute to peoples pain via failed surgeries, medical errors, misdiagnosis and underdiagnosis. Providers, we all know like to claim pain is in peoples head- for that relieves them of having to deal with the physical aspects of pain.. We know that providers often don’t care for people in pain and are disrespectful. Providers often give up after standard solutions fail- and therapeutic inertia sets in fairly quickly in pain care.
So lets talk about change in pain care- providers need to get their act together and reduce medical errors, misdiagnosis, disrespectful attitudes, and claiming pain is in peoples heads.
Changes should begin with providers- let them fix their own minds, emotions, behaviors- before they start to talk about the emotions and behaviors of people in pain.


Well said!