Pain Discussion Brought to Twitter

Pain Discussion Brought to Twitter

By Ed Coghlan

The psychology of pain was a topic of a Twitter conversation hosted by the Stanford University Pain Medicine on Thursday.

“It shows there’s not only huge interest in bring awareness to pain psychology but also providing education about pain psychology,” said Beth Darnall, Ph.D., who is a pain psychologist at Stanford.

The numbers seem to support her claim, since the one hour Twitter chat reached over 66,000 persons worldwide.

In addition to Stanford, the American Academy of Pain Management, American Pain Society, the Southern Pain Society and For Grace were organizations that promoted the effort.

You can still participate by going to Twitter and using the hashtag #PainPsychChat. During the live sessions participants were asked to comment on five main questions:

  1. Pain is not “all in your head.” But the brain does process all pain. What does this mean for treating pain?
  2. How do your thoughts and emotions affect pain?
  3. What is pain catastrophizing? What are its affects? Have you had experience working to decrease it?
  4. What is the science on mind-body treatments like meditation, yoga, others? What’s your experience w/ these treatments?
  5. How can psychotherapy help with pain? Have you had any experience with therapy for pain?

“We chose those questions to elicit a real conversation and allow people to feel comfortable really and encouraged participation,” Darnall said.

Some of the commentary that was generated during the chat reminded pain patients that their pain is not in their head. Here are some of the comments:

“Your pain is physical and real! But your emotions impact your pain and need to be part of treatment.”

“Pain can trigger depression,  anxiety, & sleep changes. Depression & anxiety can also impact how you experience pain.”

“Pain catastrophizing is a pattern of responding to actual or anticipated pain w/ great distress. Pain  Catastrophizing can make acute pain become chronic pain.”

“There is at least some consistent evidence for physical interventions with lots of psychological overtones, like tai chi”

Psych treatment must include learning skills/tools to manage pain and distress- not just talking about pain.”

The twitter chat brought the pain community together in real time, pain leaders, phsyicians, mental health professionals and of course, patients all able to talk with each other.

“This was an important step in dismantling misconceptions about what it mean to be referred to a pain psychologist,” Darnall added.

This won’t be the last of these types of digital gatherings.

Nor should it be.

Are there questions you think should be added next time? Let us know.

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Authored by: Ed Coghlan

There are 19 comments for this article
  1. Krissy at 2:26 pm

    Dave, I agree. I just put out an “opinion” piece today on dealing with change (you’ll see it) and a number of people are reacting as I expected — they didn’t get what I was saying. I am a patient on high doses of two opiates and am sure not interested in giving them up — that’s all I have, but we have to look at what is changing in our situation. Anyway, thanks for writing again.

  2. Dave at 10:53 am

    Krissy- Yes no doubt the doctor was fishing for a back patient- and I did find it pretty amusing.
    I don’t worry about my own care- but this experience reminds me of how medicine has too much control over the care of people in pain- and people in pain have too little control over their care. And so I get upset when I hear doctors trying to coerce people in pain to receive psychological care- just as the doctor tried to coerce me to receive care for back pain that I didn’t have.

  3. Krissy at 5:14 pm

    SHE MUST HAVE BEEN FISHING FOR LOWER BACK PATIENTS. SOME OF OUR STORIES ARE LAUGHABLE!

  4. Dave at 2:25 pm

    I understand that a person in pain might meet the clinical criteria from the DSM V for “depression”, “anxiety” etc. The danger is when professionals chose to “psychologize” peoples physical pain as being psychological, either in origin or as a sequelae of pain. The provider should accept the person in pains definition of their problems and their needs. FOr even if a person in pain has depression- they may not wish for that provider to address it- they may wish to do nothing or deal with their depression on their own.
    The other problem with the psychologization of pain is confusion over the role of symptoms in pain. Sympathetically induced pain might come from stress or anxiety- now does that mean you focus on the stress, the anxiety, or on all. Since medicine doesn’t use complex adaptive systems or the theory of constraints- they may be inclined to treat all symptoms- and that could be a mistake for, once again, what matters is what the person in pain wants addressed.
    If providers will just respect the wishes of people in pain regarding what they wish to address and how- this discussion would be moot. But it is not moot for providers wish to dictate to people in pain what they should and will have and my how they suffer from “the curse of knowledge”.
    I had a funny experience once where I had to see a doctor first before getting PT for a stiff neck. The doctor three times asked if I had lower back pain- three times I answered no- the third time- I hit my lower back with my hand- because the doctor wouldn’t take my word for it- and if that didn’t convince her- I would have offered her to hit my back, herself.

  5. Jean Price at 12:33 am

    Krissy…I’m a little confused about your comment to me, but I’ll try to explain. Although I wouldn’t pretend to know your thoughts, I don’t feel you were saying our healthcare was taken over by psychiatrists either. As for the “fear you heard”, that is merely my frustration/anger/sadness for those who are enduring more pain because their medications are being reduced, and most aren’t even receiving other types of pain treatments to compensate. It is also my concern that, as this article stated, there is beginning to be a major emphasis on mental health issues as a CAUSATIVE factor of chronic pain. I agree that mental wellness is important, and I don’t think “people” aren’t open minded about this and other modalities of treament. They are just focusing on the issue at hand which happens to be the denial of opioid medications for treating chronic pain. No one is threatening to take away the other therapies, but they are taking pain medications away. So I think that’s why it can seem like opioids are viewed as the only thing needed. I do think there are many differences in mental health from the 80s, so I suppose I’ll just have to agree to disagree. Rest assured my “fear” is merely my way of saying I care deeply what’s happening from a personal and professional point of view, and I think more changes are in store, SOME of which won’t likely have a positive impact on living with pain.

  6. Krissy at 10:14 pm

    Thank you for that! It makes sense, finally.

  7. Richard A. Red Lawhern, Ph.D. at 11:19 am

    As a 20-year layman advocate, research analyst and webmaster for chronic neurological face pain patients, may I add to the discussion? I have communicated with over 10,000 chronic pain patients, many of whom deal with what has been called (in my view inappropriately, but none the less tellingly) “the suicide disease” [Trigeminal Neuralgia].

    In this volunteer effort, I have often talked with people who were referred for psychiatric evaluation for the mythological condition called “psychogenic pain syndrome”. The more recent incarnation of that mythology in the DSM-5 is “Somatic Symptom Disorder”. This mental health label can be applied to any patient who, in the opinion of a medical doctor, is “overly involved” in a search for explanations and therapies for their medical symptoms, at the expense of other activities and involvements in their daily lives. When mis-applied, the label can result in patient deaths and already has.

    This label can be applied to any “difficult” patient who resists a doctor’s assertion that there is no medical explanation for their pain and they’ll simply have to learn to live with it. Once applied in a medical record, it can effectively end the willingness of most medical practitioners to expend time in further efforts to accurately diagnose and effectively treat whatever is really going on. The end result can be a sharp increase in the patient’s level of despair and isolation, leading to a major increase in suicide risk. I have summarized the grounds for this observation in a research paper titled “Psychogenic Pain and Iatrogenic Suicide”, on the Global Summit for Diagnostic Alternatives sponsored by the Society for Humanistic Psychology.

    From time spent interacting with chronic face pain patients, I have come to believe the following:

    1. There is no validated body of medical evidence to demonstrate that chronic pain can proceed from or be caused by any mental or emotional condition, in isolation from a physical cause. For deeper background on this observation, I refer readers to “Authors of Our Own Misfortune? Problems with Psychogenic Explanations for Physical Illness” by Angela Kennedy (available on Amazon).

    2. There is ample validated medical literature and patient experience to demonstrate that circumstantial depression and social isolation are frequently co-morbid with chronic pain. One of the mechanisms in this association is simple physical exhaustion and sleep disturbance due to pain. Another can be the incomprehension and withdrawal of significant others who find the chronic pain patient no longer meets their social or family role expectations. Chronic pain and hopelessness are genuinely depressing, and depression can in some people increase their sensitivity to pain from physical causes.

    3. The latest generation of anti-depressant medications have no more effectiveness than placebo in mild to moderate clinical depression. More powerful drugs used in severe emotional or cognitive distress are outright dangerous and counter-productive. The evidence is well summarized in “Psychiatry Under the Influence — Institutional Corruption, Social Harms, and Prescriptions for Change”, available on Amazon.

    4. Cognitive Behavior Therapy may be useful for some patients some of the time, but appears to have been greatly over-promoted as a false panacea. If imposed on a patient against their will, CBT can itself become a source of depression and alienation by communicating a professional attitude of indifference and non-support: “you can reduce your pain if you’ll only change your attitude and stop catastrophic thinking.”

    5. There is at least fragmentary medical evidence that several forms of mindfulness practice and non-impact exercise can be constructive to reducing pain sensitivity and perceived misery. These include walking, breathing exercises, meditation, centering exercises, Yoga, and Tai Chi. Highly aerobic and impact exercise such as Pilates or marathon running can seriously increase pain levels in any form of neurological pain.

    6. Pain and isolation can result in significant grieving for real life losses. Therapy which addresses loss and looks for practical ways to overcome it may play a positive role in patient management of their own health. Not all patients are responsive to this approach, nor should anyone be coerced into using it.

    7. Opiates are central nervous system depressants. When used in chronic pain patients, monitoring for deepening depression or suicidal ideation should be mandatory.

    That’s my two Red cents, for whatever they’re worth.

  8. Kristine (Krissy) at 9:48 am

    Jean, I don’t think my thoughts lean toward professing we all need to be considered mental patients, nor do I say that I see our healthcare taken over by psychiatrists and unnecessary medications! I do see fear in your comment though, but I would say not to fear. There is nothing happening with mental health that wasn’t happening in the 1980s. I am talking about change, but it is more about attitude change than anything else, and has little to do with mental health. My statement should have been better written to reflect that. I agree there are many levels of mental health and there is not always a need for aggressive treatment, but it is complicated, as patients can easily hide serious issues in depression — I know because I’m really good at it 🙂

  9. Jean Price at 12:21 am

    Krissy….I agree that depression can be a normal part of life with pain at times, yet this is just it…that’s NORMAL!! Not pathological, unless it drags on and affects a persons life style. Our life styles are already impacted by pain in similar ways, and without proper pain treatment, it’s going to be impossible to distinguish normal depression from pain from pathological/clinical depression that does need mental health treatment intervention. My fear is that all depression will then be labeled as needing treatment, instead of addressing the loss issues and giving patients a few needed tools to deal with the normal type of depression themselves. This is already apparent in other areas of health care…many doctors are all to ready and willing to prescribe antidepressants yet not talk to the patient about what’s bothering them or direct them to support groups or other areas of help with coping instead of just treating them as if they were clinically depressed. To medicate is to lessen processing, for the most part…and so people aren’t given the opportunity to explore and possibbly lessen their depression before they are put on medication. Many grief counsellors would only medicate someone in crisis, and have a given time frame in mind before the patient could go off the medication and begin exploring and talking about their depression to hopefully lay it aside. For those of us in pain, our depression can ebb and flow…greatly dependent on our pain levels. So having appropriate pain care is even more important and we are already seeing that get lost more and more in the shuffle. The final result will be more NORMAL depression that may very well escalate into PATHOLOGICAL/CLINICAL depression…but due to inadequate pain control. Yet, they’re not going to see this, in my opinion. They will see pain and depression as both being mental issues. Increased suicides will add validity to their point and pain will be relegated and coded for treatment from mental health professionals, period. And this makes me depressed to think about!! If this does happen, it will be a sad day in health care and we’ve all seen way too many of those already! I do agree that we all can use some help understanding loss and grief because our lives with pain have had these issues surface. Yet, it doesn’t take medication or psychologists to give us that. The advocacy groups are remiss in including much about this, in my opinion. I have asked the foundation about getting some information out and maybe even speaking at their seminars on this, yet had no response at all. So this is my big concern when I see an article addressing this as if it were insightful and yet making such statements as to catastrophizing being what leads to chronic pain! That’s just plain wrong. And it doesn’t validate the need for aggressive pain management at all. One more dangerous step, I believe. And hey, I’m so sorry about your wrist! I can’t imagine trying to type one handed or with a restricted hand! I have enough trouble as it is. Hoping for a swift and complete recovery for you. I know that’s something you need for your writing.

  10. Kristine (Krissy) at 5:58 pm

    Dave, read my comment again.

  11. Dave at 3:12 pm

    Krissy- there’s more to dealing with pain then pills, prescriptions and psychotherapy. I required no pills to treat my pain -and no psychotherapy- in fact no medical treatment to overcome my fibro. In fact the man treatments I tried were of no discernible benefit.
    Stanford is trying to promote their occupational strategies and that people in pain are mentally deficient. In the old days of psychiatry and psychotherapy- this was known as alienism.
    Medicine wishes to tell people in pain what their problem is and what they can do about it. They don’t wish to listen to people in pain and work on developing and using approaches that are mutually agreed upon.
    Yes- change is a four letter word to the medical industry- they don’t wish to respect and fully consider the views of people in pain. That would require a lot of change on their part. And frankly they really cant deal with the complexity and diversity of people in pain. They lack the cognitive skills for that. They will not recognize and fully address their deficiencies They are way too proud “certaintists” for that. So they use the big lie technique to try to convince people in pain that they are catastrophizers. If they believe all people in pain are catastrophizers- maybe they should help “catastrophizers” get disability for catastrophizing.
    But frankly, I think they are having a hard time selling their belief to people in pain that they are mentally deficient. Its remarkable how little they focus on respecting how well people in pain hold up despite the keystone cop- like pain care system that medicine and society has created that adds a treatment burden onto the symptom and adjustment burden of pain.

  12. Kristine (Krissy) at 11:01 am

    Excuse my typing, I broke my wrist.
    Other than the part about a Twitter situation here, this article’s content represents some very important issues. I think some pain patients are getting a bit close-minded, focusing on medication as an “all I need” solution. I’m not saying medication isn’t a #1 part of our treatment, but it isn’t the whole thing. One big beef that we’ve all expressed is, how can we afford other treatments when they are not covered by insurance? I believe we are going to find insurance paying for more alternates in the future as treatment changes. I also believe the changes will take time — not to panic, but keep your eyes open.

    Help with depression, anxiety, etc. are extremely important because we all handle our grief differently, and if anyone in high-level, chronic pain tells me life is all sunshine, I wouldn’t have it. Psychology and psychiatry play an integral role in pain management. We often live in this vicious circle where pain doesn’t allow us to do the things we want, and that can cause depression. Or depression can cause us to be more sedimentary so we can’t do what we want in that situation either. We don’t want to be labeled “mentally ill,” but why? It’s because of stigma, of course. But my broken wrist is an ill wrist, My broken psyche is an ill brain, which is, dah, mental.

    What about those who have committed suicide? I don’t think anyone would argue that some of them would have benefited from serious pysch treatment, or if they were already getting it, a change of the couch.

    We must open our minds to some changes (not all because some things are a matter of opinion). But some things are a matter of fact, too, like when grandpa refused to even try to use a cell phone or tablet, we thought, “but he would love it if he only knew what he could do with it!”

    (Some of my comment comes from an article I am writing about change.)

  13. Angel at 10:31 am

    For a lot of us doctors have used psychology as a weapon and tool to dismiss us and deny treatment. Until this stops pain patients won’t be as open to this. I was told I was nuts and put on antidepressants labeled a drug seeker until a new doctor found I had been suffering years with chronic leukemia eating away my legs my brain and my spleen and liver. That pain wasn’t in my head. I should’ve sued the precious doctors but was too busy on chemo. 13 years later I’m still in incredible pain still on palliative chemo. But atleast now I know I’m not crazy.

  14. Kathy Cooper at 10:28 am

    I have been following Stanford’s Neurosciences for a while now. I have been following them in an effort to figure out the what and why, behind some of the “Confusion” in Pain Management. I have also tried to figure out the overall picture behind the current Media Created “Opiod Epidemic” and some of the Pseudo Science they are touting as an alternative. On top of these issues I have been following the “Healthcare Debacle”, the current Failing and Expensive U.S Health Care System. The Most expensive and last effective Healthcare System in the world.
    No one can argue that the Medical Industry, the Pharmaceutical Companies, and Insurers have Billions of Dollars. The Pubic is also aware that our Policy Makers, and Congresses have experienced undue influence because of this money. This is enough money to influence the Media if not outright control it. There is also enough money to monitor Public Opinion and influence it. They can use very sophisticated methods developed by Advertising. Public Relations is another way they manipulate and distort the issues. This is enough money to influence our Politicians Policy Makers, and even get Industry Insiders to if not only influence Regulatory Agencies, but actually become the Head of the FDA as one example.
    Certainly there are Psychological problems such as Depression, that go along with Chronic Pain and other Physical Health Conditions. The focus on these “Psychological” Issues instead of the initial problem and without the Context of the Initial Problem lead to more confusion and obfuscation. The Industries have promoted this, and the Media as it does with many issues, only repeats the message without context.
    Recently the wording in the DSMV ( the Psychological Reference Book) has gotten changed to include Psychological Issues related to having a Chronic Illness or Pain. In most cases a competent Profession would have the context, and be able to discern that the Patient is in distress due to a Physical Condition. Like anything else this is generally mis-interpreted. The Insurance Companies require the use of a Billing Code for everything, and the DSMV is used as the reference for Billing. It appears that these few words can be easily be interpreted to mean that having any chronic Illness is a Psychological issue, or that the Psychological Issue is Primary.
    This has been a boon for the Insurers, and other Medical Businesses that profit from Health Care. It opens up a new Market for Pharmaceuticals, expensive ones with little benefit, but more appealing and financially rewarding than dealing with Chronic Pain or other Illnesses. Not only can they ignore the initial condition, now they can further dismiss the Patient with a Stigmatizing label. There are also other Psychological Labels to do with people obsessing over their Illness, now that is a Psychiatric Disorder. Since Pain is not mentioned this is left out of the considerations for “obsessing or thinking about an Illness too much.” The issue with pain that they fail to mention is that unlike some other diseases and health problems one can’t just ignore it. Or if it is at a certain level it is impossible to ignore. The presumption is that if the Patient even mentions it in a Doctors visit, or talks about it they are “Mentally ill.”
    When Stanford Neurosciences Publishes these “Articles” they are out of Context. Of course these interventions might help to alleviate pain, perhaps for some people and specific situations, they work well. Since many of these “Scientific Articles” and “Breakthroughs” don’t show the Data Source, or funding source, they are not really Scientific. The General Public and many Health Care Practitioners take them out of context, and think this is a legitimate Alternative. This is why we are here now. Many Pain Patients have used these methods for Years before seeking Medical Intervention.
    These Articles also perpetuate the Myth that Pain Patients are Unaware of these alternatives and realty don’t know what is good for them.
    These Myths and Misdirections have been very good for the Health Industry. How else could we have a debate about this? How else could anyone justify not alleviating pain, even for a Cancer Patient? Look at the big picture, we have the most expensive Healthcare System in the World, and these tactics have not been limited to Pain, they have used this to ignore or deny other conditions too. They have had many years of research from the Low Income Clinics in how to Deny Medical Care without sounding any alarms, and get the Public to believe it is in their interest.

  15. Marian Medvec at 10:01 am

    The three large medical centers in my area are all complying with the DEA’s guidelines, or whoever they are. So no more opiate drugs for any chronic pain other than cancer. They defend with this idea. If you have a UTI and we give you medicine and it doesn’t work, then will try something else. Same with pain! So if you take a pain pill and your pain doesn’t disappear forever, then you have to go to something else, like biofeedback. I am a long-term pain patient and I am here to say that drugs do help, no I am not addicted, but so what if I was. I cannot live with my pain. By live, I mean there is nothing I can do, no where I can go, I can’t walk to parks, festivals, can’t even walk around the block due to pain and other issues related to back problems. So I can sit here, and that is it. Can hardly do house work anymore, no gardening. I would rather not live anymore like this. It is not living.

  16. Jane at 9:15 am

    Dave and Jean, you have really put your finger on the pulse of the pain patient. Pain is not controlled by attitude, depression, or mood, and I don’t see how mental therapy can help all pain patients. Pain is exactly what it is; PAIN. Yes, it is mentally challeging to live with a chronic pain condition, but I couldn’t imagine anyone wanting to be in pain. It’s REAL, it is not due to being dependent on medication, other than trying to live our lives with some function, to enjoy life without being immobile and suffering. It is not a state of mind, it’s a state of PAIN. Yes, pain does increase depression, anxiety, worthlessness, but I have faith that I will make the very best of everyday that I have been given, I am faithful to pray, which helps me, others may not agree, but it helps me to find joy. Please don’t continue building those walls around genuine people with genuine pain by throwing uneducated conclusions around us!

  17. Dave at 7:35 am

    Pain ‘catastrophizers” is a pejorative term invented by pain specialists to send people that they don’t like pain to cbt or to obtain psychotropic medications. We know doctors- including pain specialists are challenged by the difficulties of caring for people in pain. Doctors are using a mind projection fallacy to contain people in pain who are having a difficult time due to not getting effective pain care. So they wish to blame to the person in pain rather then recognize and address their own limitations.
    It would be a mistake trying to pawn off the difficulties people in pain experience as being psychological deficits. The deficit in pain care is clear- the longstanding neglect of and mistreatment of people in pain. As Ida Rolf wrote- take care of the pain and the psychology will take care of itself.

  18. Jean Price at 11:57 pm

    Well of course there are psychological undertones for those in pain! But this article is scary to me because these are normal reactions to the loss and changes that come with chronic pain. And I feel this article is opening the door to labeing this abnormal, and therefore in need of treatment! Will the next step be to label and code chronic pain as a mental health disease? That would be devastating and it could easily sound the death knell for further research and aggressive treatment of pain, in my opinion! Most people could benefit from some simple change/loss/grief classes designed to help them understand and process their feelings. These people have had dramatic changes and many accompanying losses when their pain conditions lingered for weeks, then to months, and on into years. Yet this is normal grief and in need of support, but not psychiatric care or lengthy therapy regimens. If pain is relegated to the world of mental health, insurance companies stand to benefit greatly since they usually cover only 50% of those costs, and have time or money limits!! People in pain are not mentally ill, and they shouldn’t be included in this group. They have already confused us with addicts, and are attempting to remove us from standard medical treatments for pain. So it begs the question…is this where we’re headed? I hope not, yet I wouldn’t be at all surprised. Especially with their statement that “pain catastrophizing can lead acute pain to become chronic pain”!! That’s saying chronic pain is caused by over reacting and being in distress about being in pain! Seriously, that is not a valid causative issue! And the funny thing is under treating pain leads to being distressed and anticipating worse pain, so how does this play out in their theory? Once again, I leave an article feeling like yet another shoe just dropped and we are out on limb with no visible means of help!

  19. TIm Mason at 7:47 pm

    This sounds great! I hope the group will involve doctors in the fields psychiatry and pharmacology too.
    The form I fill out at the pain management office where I go has questions about your current mood. Sometimes I would indicate mood improvement and sometimes I listed anxiety that I was having. Recently, I commented about my entries and asked if they addressed this as part of pain management. The answer was “No, we don’t address it, we just document it.”
    The report and statistics that come from this endeavor will be very interesting to a great deal of people.