Absolutes in Chronic Pain Treatment Can Backfire

By Ed Coghlan.

Beth Darnall PhD is a pain psychologist, noted researcher and Clinical Professor at the Stanford University as well as successful author on chronic pain. She and her research team have just landed a major grant to study chronic pain. We interviewed her on the grant, the opioid controversy and the National Pain Strategy.

NATIONAL PAIN REPORT: “Beth, you wrote a great piece for Huffington Post last year that argued more needs to be done to address chronic pain than just limiting opioids. Yet it seems a year later, little has changed. The attack on opioid use has intensified but alternatives are seldom heard. Thoughts?”

BETH DARNALL: “Humans tend think in binary terms and we are certainly seeing that play out with opioids. It’s not a black or white issue. We need to allow for the grey, and that means treating each patient with respect for their individual factors. I have always worked to help patients need fewer medications to manage pain and symptoms. That does not mean that medications and opioids have no place in pain care because they do. Getting away from the binary thinking allows us to appreciate that physical, self-management and psychological approaches are important for each and every one us – regardless of whether opioids are taken or not. Many people who use these modalities find that their medication use is reduced, but not for everyone. In the current political climate absolutes in either direction will backfire against best patient care.”

Beth Darnall, PhD.

“You raise the point about opioid alternatives receiving scant attention. Recent articles in Scientific AmericanTime MagazineThe Washington Post and the NY Times are helping to get the word out about non-drug pain management strategies. But at the end of the day patients need better access to skilled providers and treatments such as physical therapy, cognitive behavioral therapy for pain, Mindfulness Based Stress Reduction, and chronic pain self-management. Insurance barriers often prevent patients from accessing this care. And, often patients cannot find skilled therapists where they live. We need policy changes to better support insurance coverage for non-drug pain treatments, and we need better federal investment in chronic pain treatment education for physicians, psychologists, and physical therapists. Ultimately, we need to improve access to the lowest-risk evidence-based pain treatments.

NATIONAL PAIN REPORT: “I recently spoke with Bob Twillman, executive director of the Academy of Integrative Pain Management who was arguing that implementation of the National Pain Strategy is slow to non-existent. Do you agree?”

BETH DARNALL: “Yes. Dr. Twillman is spot on. A federal task force is being developed, so that is promising. But solutions have been slow while the opioid reduction policies have been quickly implemented. It’s easy for me to play armchair quarterback, but I wish policies that targeted improved non-drug pain treatment had been implemented before opioid reduction policies were enacted. Many patients have been traumatized and suicide has been a horrifying outcome for some. I understand the rationale of federal and state policies, but the implementation has not been supportive of patients with chronic pain with tragic consequences.”

NATIONAL PAIN REPORT: “I follow you with great interest on Twitter and noted an added emphasis on patients taking control of their lives, more exercise and lifestyle adjustments etc. Share some tips for patients who are looking for a better way. “

BETH DARNALL: “I wrote 2 books on this very topic! It is difficult to provide tips without sounding trite to those who have chronic. But interested readers can check out these two free articles I recently co-authored in Time Magazine, and The Washington Post with Dr. Emma Seppala. A short sound bite is that our thoughts, emotions, stress, and choices all impact our pain and can make it better or worse. If you don’t have the right information and formula to help keep your pain as low as possible, you will need more medical care to manage symptoms for you. That’s a trap. Opioids or no opioids, I encourage everyone to learn everything they can to train their brain and body toward relief. It’s not a one-off solution. Pain management is a lifestyle.  Just like someone manages diabetes with a focus on healthy daily behaviors, chronic pain self-management is dedication to active, empowered living. Karen Duffy, a.k.a. Duff Lambros (actress, author and former MTV VJ) is such an inspiration to me and countless others. She has lived with severe debilitating chronic pain for many years. She states publicly that she uses opioids, and states that her foundation for pain relief is her daily dedication to actively self-managing her pain and symptoms. Opioids are just one part of her overall pain care plan. By the way, she has a fantastic book coming out later this year and I highly recommend it!”

NATIONAL PAIN REPORT: “You were just awarded a sizeable federal grant. Congratulations. What will it allow you to work on for the benefit of chronic pain treatment?”

BETH DARNALL: “The Patient-Centered Outcomes Research Institute awarded me and my research team $8.8 million to conduct a multi-state study to help patients with chronic pain reduce pain, opioids and associated risks. We aim test the ability of behavioral treatments to facilitate pain and opioid reduction. Nobody wants to take opioids, patients just want less pain. It is important to note that we are not forcing anyone to reduce their opioids in this study. We are only studying patients who want to enroll in a patient-centered opioid reduction program – it is voluntary. I am constantly amazed at how many patients tell me they want to reduce their opioids but do not know how or fear they cannot do so. This project is for them. Patient partners helped us design our study, and we are measuring the outcomes patients told us are most meaningful to them. I’ve been talking about what needs to happen for years; with this award I am honored to lead the work at a national level. We aim to provide patients who wish to reduce pain and opioids, their families, and their physicians with the evidence they need to successfully meet these health goals.”

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