AAPM Meeting Called Cohesive and Focused

AAPM Meeting Called Cohesive and Focused

By Beth Darnall, Ph.D.

The American Academy of Pain Medicine met in Vancouver last weekend amidst the health crises and pressures being brought on by the pressure on opioid prescribing and pain treatment.

We asked Stanford University’s Beth Darnall Ph.D., a nationally known pain psychologist and author for her observations about the meeting and what it might mean for physicians, psychologists and individuals seeking pain relief.

Here’s what she shared.

We need the National Pain Strategy

“It was recognized that we need implementation of the National Pain Strategy. The NPS is an incredibly well-thought vision created by our nation’s leading experts in the field. Implementation has yet to be realized, but acting HHS CMO Dr. Vanila Singh spoke at AAPM about her co-leadership with Dr. Linda Porter to begin tangible steps forward.

More Mental Health Care Is Needed

“Physicians/prescribers/non-psychologist clinicians are desperately seeking solutions to connect their patients to mental health care – and specifically, to pain psychology experts who can apply evidence-based behavioral pain medicine strategies. As described in our 2016 publication on this issue we have a dearth of pain psychology specialists in the U.S. – meaning those with specialized training and expertise in evidence-based psychological pain management.

Beth Darnall, PhD


“Pain training is needed across all health disciplines. To address the gap, myself and colleagues held a 4-hour behavioral pain medicine workshop on Sunday 4/29 to begin to equip healthcare providers with foundational understanding of the role of psychology in the experience and treatment of pain, and to provide them with a toolkit of resources that they can implement in their clinical care pathways in the absence of psychology providers. Resources include online treatment pathways, books, videos, and other materials. Two online resources are the website for the American Chronic Pain Association and Toolkit.Org  Both have free and very low cost downloadable education resources for patients and providers alike.

More Insurance Coverage

“We need better coverage for interdisciplinary and multidisciplinary pain care. This is a perennial problem. This year, a preconference led by the now past-President of AAPM, Dr. Steven Stanos, included insurance payers as key stakeholders in the conversation that was focused on solutions.

“Payers are now mobilizing to create portfolios of behavioral pain medicine treatments to provide patients with immediate access to pain relief tools (Sedgwick is one cutting-edge example focused on helping to connect injured workers to digital care solutions).

“There is a major focus now on integrating or embedding psychological services into primary care. Individuals with pain stand to benefit greatly from this integrated care model, wherein problems are addressed early on, and empowering self-management education and resources offered right away. Multiple federally funded projects are testing these models and methods.

“Many pain physicians are beleaguered by increased authorizations (and rejections for care coverage), DEA policing, and increased documentation. Combined, these pressures are creating unsustainable conditions that may further compromise patient care.

Pain Is Complicated—Let’s Treat It That Way

“The imperative to address the suffering of individuals with chronic pain was a major theme throughout the conference. A one-size-fits-all approach flies in the face of everything we know about pain. Pain is fundamentally individual and requires individual approaches. As such, great concern was expressed for rigid rules and policing around pain treatments.

“We are seeing greater evidence and attention on evidence-based pain treatments, such as pain-CBT (cognitive behavioral therapy), CBT for insomnia (CBTi), and emerging therapies such as virtual reality; these treatments were featured in the conference line-up.”

Look for Dr. Darnall’s editorial titled” “To Treat Pain Address The Whole Person which will be published  in Nature Magazine and online this week.

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Reading this made me want to throw up. Have any of these “experts” had severe pain for even a whole day??? Have you??? That’s the most tragic part of the chronic pain issue…only someone who has experienced it actually understands. These ridiculous suggestions would be comical, if the situation weren’t so dire and tragic. Yes, every suicide will be on the hands of all the non-pain people who are controlling our ability to have any quality of life. How very very silly this article is.

I just read that Robert Patterson of the DEA has claimed marijuana has killed people. This is so outrageous and does not surprise me that he could not back up his claims. He finally admitted the deaths were actually other drugs laced with marijuana. Just proves how misinformation and down right lies have harmed chronic pain patients causing the suffering of millions of people. The DEA employees are not Dr.s plus they know absolutely nothing about pain management. We all need to file a class action suit against these people who have stolen Dr.s ability to treat their patients. How many people have to die from untreated relentless pain driving people to commit suicide. Shame on them all. How down right evil. OUR civil rights have been stolen. For every suicide I blame them.

Alan Edwards

I am happy pain management psychologists had a productive meeting in Vancouver. No specific plan for pain control was put forth. The dearth of psychologists and ph.ds are waiting to tackle the problem of opioid deaths or overdoses now topping the entire death count of over 50,000 during the Vietnam conflict per day. Not per month or year, per day due to opioids.The world death rate is about 150,000 per day meaning intractable pain patients and abusers of opiods cause over 33 percent of world deaths daily. Opioids are the new king cobra of death, surpassing old age, heart disease, cancer, doctors, and car accidents.Pain killers are the most lethal substances on earth. The United States population should be declining. Hospitals should be emptying and morgues be overfilled. Baloney.

I heard this report twice last week from another anti-analgesia group. Remember the comparison to World Trade Center deaths? 3000 intractable pain patient fatalities per month -made by the usually reliable Tucker Carlson last year or before.This was another false government or Kolodny statistic.

Psychologists can provide moral support for intractable pain patients but can’t even prescribe.
Amitriptyline/Nortriptyline is a doctor favorite which was nearly fatal for me had I not stopped it. After decades I have not seen a single death caused by lortab in my county. But I have seen experts lie about there being enough ‘opioid overdoses and deaths to collapse the entire United States population’ in less than a decade.

Opioids are a blessing to those of us who follow NPR. Not a killer of 57,000 per day or 3000 per month..

Pain management experts are going in the wrong direction using ineffectual, expensive modalities. Physical therapy at 500 dollars per hour does little for IP disease. I recently finished 8 weeks of it again. I cannot afford it and was unsuccessfully pressured by the Physical Therapist to say it had lessened my intractable pain .

Too many mistakes are being made by medical and governmental elites when chronic pain patients often have the clearer ‘vision’ of what can get them to work or grocery store every day. Chronic severe pain or Intractable pain can be stopped now without endless discussion. Things are getting ridiculous.


Ms Darnell, please refer to my note from 2 days ago.

I think I was too subtle.

The kind of pain I deal with on a daily basis is at a level none of you pain psychologists will ever deal with if there is a God. It is so painful I become incontinent. (I think that is pain enough to warrant a pain pill or a good session with a mental health counselor to “talk” the pain away maybe? Maybe not. I HAVE TO SHOP. It is not a covered function of my insurance but I LOVE TO SHOP..So why should I be reluctant to take something that will possibly control it? Why should pain doctors think for a second I am pill shopping? I have valid- verified pain not imagined pain. I don’t get high- I just possibly will make a shopping trip without filling my pants. Possibly keeping my bowels from letting go when spasms of pain cause this.)

I will always have this hardware in my back. This pain. Won’t go away in 2 weeks.

So how do we schedule an end to my pain pills?

The only thing that will stop this pain will be my death. As you age, pain like this intensifies because of less movement, because of arthritis, because you are aging.

Is death a valid answer when prescription opioids can lessen this?

I rarely take more than 1 5/325 in a day. Addiction? No. I sleep or lounge mostly but please don’t encourage them to take away what I *do have left.* Leave me with SOME SEMBLANCE OF A LIFE.


My apologies to Ed.
Its remarkable to me that Its almost 7 years since the IOM report on pain care in America was written and now Dr Singh- talks about making tangible steps forward with the NPS.
John Bonica indicated from 1800- 1950 there was little conceptual progress in pain care. The NAS last year indicated there were few new medication for pain in 20 years. A few years ago Dr Wanda Jones called the NPS- ” a beginning”. Its clear the iron triangle of government, academia, and the health care industry, for quite some time has not cared enough to move pain care forward.
Tragically Dr Singh isnt gonna set the world of pain care on fire- and neither will the NPS, or the new pain management task force. They simply, dont care that much about peoples pain. Who could doubt that if it wasnt for the opioid problems that the government wouldnt even had bothered to ask NAS to write a report on pain or Singh to get together the old boy network in pain and addiction to create a new plan.
I vote no confidence in the NPS or the new efforts of DHHS -theres no visionaries on those committees and no one I admire. Its resume builders for them and no doubt theyll call for NPS 2.0 to keep building their resumes- i doubt people in pain even know about NPS and soon it will be another failed project by NIH/DHHS.
People in pain should call for those who really care and have real ability to woork with people in pain to create a real plan to improve pain care. The top down designs of Singh and her colleagues can only fail people in pain.
Dr Singh was hired to maintain the status quo in pain care and that is what she is doing.


Lets not kid ourselves. If PM is ever returned to some semblance of normalcy: we’ll be jumping through endless hurdles, hoops (+new age of PM=virtual imagery & “feel-good” phsyco analytics) sigh/-:
Reading an article the other day addressing the “opioid crisis’’ I was astounded; to be reading solutions/suggestion & commentary from people who have no idea what a day in the life of a CPP is like: as follows-
1) how about a drug database to monitor pts receiving pain medication (((laughable)))
2) studies show these medications do not help alleviate CP.
3) theres too many drs handing drugs out like candy!
4) “If you happen to need surgery; just don’t take any pain medication; nsaids wrk fine!” ((Missing the whole point: MUCH))
5)Addiction started in the drs ofc & pain rx’s are responsible for 60,000 OD’s a day ((whatttt???)))
[for the record]
Drug databases-have BEEN enacted for years now. Secondly, we are tired of being told what we know works safely (for years) is ineffective, AND distribution cuts do not allow medications to be “handed out like candy!” Physicians/pharmacys& now hospitals are reluctant to treat ANY pain! Lastly, We WERE the most over-supervised “hippa out the window” violated Patient group of ANY class! Talk about over-sight on steroids imo!! What more should we do to comply now?
****Ballantyne/Kolodny/•gov have really done a good job of breading misinformation & media is THEIR affective TOOL of choice. Hope: the light at the very far end of the tunnel..now visible > thanks to NPR, ATIP & many others who work tirelessly on our behalf.


We have Doctors turned media star like, Dr Drew Pinsky (well known for the show celebrity rehab), saying you can get past opioid withdrawal in three days. He states that the problem is staying off of them. He doesnt agree with suboxone and I personally am not interested in that option. Im still waiting to hear a sollution from him, other than Alcoholics Anonymous. Once again; label everyone an addict.


I read this again and it upset me more. NOt that the pain factor is not of vital importance but lets talk about the withdrawal when someone is abruptly cut back even one pill day for example. About 3 months ago, because my scans were clear (as far as cancer), I was to trying to taper off the percocet, in order to find out if my pain was somewhat related to withdrawal. I dont think an addict would think about that. When I told my oncologist at UCLA, she said; “you have been on those a long time and you have cut back very, very slowly.” She called a colleague of hers with some experience in this area. I dont recall if she specialized in addiction, pain or both. She recommended cutting back 10 percent or even less a day and staying on that for several weeks at least, and then cutting back a tiny bit more for weeks. However, no written instructions and no other recommendations other than antidepressants. I didnt know what to do and dont believe she did either. Ive spent hours researching this subject. There are supplements that have proven to work but come with a high price (ex. calm support, Elimidrol $135.00 for a 30 day supply). These fools that made these guidlines and did not even consider the suffering of human beings, are either Stupid or just dont give a damned. For lack of a better term, isnt that “putting the cart before the horse”. Leave it up to the government.

Opioid withdrawal isn’t minor. It’s not “just temporary”. That kind of suffering matters and its serious. This isnt something you experiement with; like a new supplement to see if you can feel a little better. This takes professional medical help that is not even close to be offered. Not talk therapy. By the way; ive been seeing LMFT for the 3 months weekly. I sure never expected her to resolved this issue. I went there to vent about situations similar to this. Two years of dealing with a medicaid govt managed health care plan is quite difficult to tolerate; especially with a life threatening disease. The hospitals in their network are life threatening. No Access to quality care, no specialist, denials, neglect ect.. Hmmm, kind of sounds like the opiod witch hunt.

Has any of these specialists personally dealt with pain themselves. The specialists need to talk to patients who have dealt with pain for decades to learn how to really address the real issues and the DEA needs to back off.


I guess we live a communist country where everything is controlled by government.

Susan L.

Why is it whenever I see “evidence-based” anything I want to run?

Jane Heinrich

I’m in bone pain. I have done all this [edit] over 37 years of pain. Let us address the fact of pain that is never ending andbis treated w/ narcotics.


Cohesive and Focused? Focus on this, Ms Darnell. While I try to regard your education and work with pain with high esteem I have to wonder.. Are you trained in the mechanics of pain or psychology of pain? I have an 8 level fusion and laminectomy with instrumentation/rod c2 to t3 and L5-6. I also have an eroded esophagus and digestive issues and am a 12 year caregiver to my 87 yo husband with Alz/Dem. And you think this can all be psychoanalyzed away? When I shop, for instance, the heavy cart twists my spine inside my body and the resulting pain makes me lose control of bodily function. What would you think was a proper way to control the pain? I always bring fresh underwear with me. It is stressful. But a benzo and a pain pill? Just a pain pill? Or just a good talking to? Did you discuss this type pain during your seminar? I am interested in how you would deal with a patient presenting this way. Or would you assume they were “pill hunting.”

Sue B

Please, please, please wake up. As much as we have lost, and been stolen from us, this would be an irreversable death sentence. The only focus here by these wolves in sheep’s clothing is GREED! Next step will be to put all us pain patients in a tiny padded cell, feeding us gruel, stealing our remaining assets, and taking out life insurance policies on us. Don’t be fooled. Don’t let this past your hard earned radar. Big Brother, McCarthyism, nepotism, greed, and blatant injustice is alive and well!


I read this at about 3am this morning when there were no comments yet. Im generally a warrior and have no problem speaking my mind about the outrageous media spin that has been put on the topic of opiods and how they are conveniently hiding the real statistics about opioid overdose deaths. I was so disappointed to see this article on National pain report. Not to mention angry. I kept thinking am I not understanding something here. Thanks to those who could calm down enough and do such an excellent job of beginning to cover the injustice of this convoluted mess.

I had a lobectomy last year; because I was not informed how much safer robotic surgery was; until after the fact. Nerve damage is permanent; yet I have manged to use only 15mg of percocet or less, in a 24hr period. I HAVE NEVER BEEN HIGH ON OPIOIDS. That has never changed. My Doctor has been very cautious and has had no problem prescribing the low dose I use. However if my cancer returns, I am very concerned about my quality of life in the future.

The majority of Doctors are NOT THE PROBLEM. The only individuals getting more opiods than they should by irresponsible doctors, are high powered people. I tried Gabapentin for a couple of days and it made me sick and loopy, so I stopped. After doing extensive research, I know that was a good decision. Doctors are too quick to prescribe antidepressants. Mixing antidepressants with opioids can cause serotonin syndrome. Ive had Doctors say they can help with pain. What if they dont and you need both. Im not depressed and have no desire to experiment with antidepresant trial and error. However, this situation is depressing.


I saw a pain phsycologist two times. I wouldn’t mind finding a different person, but the man I saw kept trying to tell me to not talk about my pain, so “that I don’t think of it so much.” It’s kinda hard to not notice when you are in constant pain though and if I’m having a bad day I’m sure as heck gonna let my husband know so that so he can help me with dinner and stuff. When people ask how I am, I always say ok, how about you. I don’t talk to other people about it anyway. I am hoping that not all pain phsycologists are that way because he only made me feel worse about myself because I can’t control my pain. The phsycologist said that sometimes breathing through the pain helps. Although it does help my anxiety, it does nothing about non stop pain. Also I do have major issues with sleeping. Both going to sleep and waking up several times from pain. I just don’t like phsycologists thinking it’s all in our head, because it is not.


I am happy that another meeting of the experts has occurred. We do have a drug/substance abuse issue that even pain management patients have to acknowledge but, exactly what does the CDC solution for drug and substance abuse so bad in many cases have to do with professional pain management? There is…….documentation and records of patients that have used opioid medication with much success and little negative issues yet all patients that use opioid medication to effectively manage lifetime pain are affected, very badly to defeat drug/substance abuse and death? The proverbial can of worms has been opened but, who now can effectively correct the situation of ineffective pain management for the millions of patients so
badly affected with a “policy” intended to reduce death from abuse?

Barbara Segeti

I’m sorry. I’ve tried it all. Vicodin is all that works. The only this keeping me on this earth is psychotherapy! The pain is driving me closer and closer to leaving this world. I have thank you for killing me letters to the pain doctors who have not helped me, or turned me away.

Psychiatrists and therapists are wonderful people to those who enjoy them, enjoy going and reap benefits from doing so. In my opinion this is just another fancy way for them to jump on the bandwagon due to the extreme loss of our life-saving medicine. I invite you to Google exactly what they do in order to “help”. Deep breathing, stop smoking, eat right, exercise and by all means stop thinking about it are just a few to mention. Oh, they also treat the depression and anxiety that comes with dealing with chronic pain. I would also imagine they now have a wonderful way in which to tell you how to deal with the loss of your opiod pain medicine as well. I don’t know about most of you but before this ludacris opioid injustice came about I wasn’t depressed and the only anxiety I had stemmed from the bouts of my thyroid being off it’s proper levels, and having to deal with my families unnecessary crazy issues on a daily basis. I know when I was taking the proper amount of opioids to control my pain and live my life, the only psychiatrist I needed or wanted was God. Still is. Sitting there for thirty minutes to an hour attempting to pour your heart out to a perfect stranger and them occasionally asking you why you feel this way, how do you think you can help yourself and of course telling you how to live a healthy lifestyle in which you already know of has never been useful to me nor will it ever be. I find it much more comforting in talking to the people on the pain news network and my physician. They truly understand and know just exactly what living with chronic pain especially without the proper amount of medication to control it can really do to a person. I’ve yet to hear one of you or my physician say forget about your chronic pain, living a healthy lifestyle is going to fix most everything and anxiety/ depression is a sickness in which we need to get rid of because it’s really not necessary no matter what you may be going through.

David Becker

Lol. The nps from the get go or should i say since the 2009 call to revolutionize pain care in america was meant to be an occupational strategy and resume builder. Its half time and Congress has essentially replaced it with the heal initiative. In 2017 dhhs did not spend a single dollar on the nps. Dr singh has yet to consider cures for pain and dr koh and mackey opposed efforts to cure pain. Dont we hear a lot aboit cures for aids cancer alzheimers etc but the prejudice against curing pain is in the minds and hearts of bigshots. As Einstein wrote condemnation without investigation is the height of ignorance. Ignorance and poisonous lack of enthusiasm prevails in pain care.
Ed may not publish my comments but lets have some fair play and lets have the truth though the heavens fall.

Rich Reifsnyder

Hello,Iam disabled and a chronic pain patient.I wrote Senators in NJ with no response at all.Since 2016 I have been writing my comments on these guidelines and nothing is being done to correct this inhuman treatment of us disabled chronic pain patients.The only one helping is Dr.Red Lewhern and now hopefully the Human Rights Group.Like everybody my pain meds have been decreased by more then half.Every month when I go to my PM Doctor my Stress Level goes through the roof and the PM office is depressing.Something has to be done Now.The United Nations Site even calls these opioid guidelines inhumane and torture.So what gives why aren’t the UN helping us,enough people died from suicides already.This is truely inhumane treatment and torture of innocent disabled chronic pain patients.This is going on since 2016 and we need help now,Not next year when we will lose thousands from suicide.We are not addicts,we have documented evidence of our chronic pain condition,submit urine tests,pill counts and still are under prescribed pain meds.All the lawyers,human right groups,UN employees that read this we need your help now to save lives.Time is running out for a lot of our Brothers and Sisters.I would never have thought my government would treat disabled people like this.To let people suffer like this is truely inhumane and torture.Yet Trumps on TV talking about Syria’s nerve gas bombing and inhumane treatment in Africa but millions of US citizens are being treated inhumanly and suffering at the hands of the CDC Guidelines.What is wrong with this picture,this travesty has to stop now.

Wilma Ingram


CRPS Survivor

Again more useless talk! We need ACTION not more talk.

Many of us are disabled and therefore on Medicare. The Medicare coverage for Behavioral Health is horrendous. I cannot find a decent psychiatrist who will take it, except those horrible places where the offices are behind glass and very seriously mentally ill people frequent. I’m scared to go to those places.

Our only option is to pay cash. Cash for acupuncture, cash for massage, cash for therapy. It’s ridiculous. We can’t afford it.

This opioid “Crisis” started because it’s cheaper to throw generic pills at us than give us alternative treatments, as they do in Europe. Now we can’t even get that!

Meanwhile even dogs get pain management but people cannot.

The authorities refuse to do anything more to stop the real cause of this “Crisis”, The Cartels who are bringing tainted heroin over the boarder in droves. I know BP Agents who say they just can’t stop the huge number of smugglers bringing in drugs from Mexico.

It’s easier and less politically risky to attack compliant pain patients than to address the real problem. So much for the Land Of The Free. If I could, I throw back their Citizenship at them!

Kris Aaron

As the meeting was in Vancouver, does this mean the issues under discussion apply only to Canada? In the US, pain patients have found very little help from the medical community (terrified of DEA prosecution) and insurance providers (no profits spent on customers’ needs). The response to our pain has become a stonefaced “No opioids for YOU; deal with the pain and don’t bother us”.
We have become collateral damage in the war on drugs. Our government is forcing us to consider risking our lives buying illegal opioids or spend our days and nights in agony. The opioid “epidemic” is a myth — we are victims of an false opioid hysteria!


It is refreshing to see that this association and other professionals are finally addressing the opioid crisis hysteria. That stopping pain meds for all is not the answer to this drug abuse issue, the issue is drug abuse, not the specific drug, addicts will always find a drug, take one away they replace with another. All the effort needs to go into treating the addict, funding treatment, improving treatment and educating the public about pain medication and how to safely use it responsibly, the enemy is not the chronic pain patient, STOP punishing them and their physicians as the government is doing right now, cancer patients are finding it difficult to get their pain medication, patients are considering suicide because their pain is not being relieved any longer, family members are desperate to find help for their loved ones. Enough is enough.


Please. Medical professionals have successfully treated pain issues for decades.
What is complicated within this agenda is lack of correct statistics, leaving long term diagnosed chronic pain issues and millions who are grappling to manage them without proven responsible opioid analgesics.
All these ‘multi’ diverse treatments have proven not to be as moderating for pain control as responsible doctor prescribed opiate analgesics.


That is just ridiculous yiu are changing an approach based on big brother taking away one of the best tools we have . Opioids. Doctors are no longer treating a patient’s pain but instead trying desperately to look at new age hocus pocus mind over matter [edit]. Long term opioid treatment works for120 mme for semblance if a normal life . 140mme ti be very stable moat of the time . They want me at 80 mme. . My ability to function without pain or as limited pain as possible is directly related tO THE MME I AM AT . after 20 years i know exactly where i am stable but now some bureucrat has decided thats too much for.me . No one gets high off if 120 mme. A travesty. Chronic pain patients protection act now

How come diabetics don’t need CBT ? Especially for sleep I really don’t have a problem sleeping. I fall asleep very easily, it’s the pain waking me up every 20 to 40 minuets waking me up telling my body it needs to change positions. Any illness can cause psychological problems. Yes especially in the beginning when your life changes due to illness and disease. But most people cope . Primary care physicians hands out anti depressants too much already. Some of us don’t need a outside person to let us know what we are feeling. This is about mindfulness again? Please I’ve had enough of excuses of not treating my pain and will not be blamed on top of everything else that it’s because I’m not being mindful of my pain or how it affects my life.