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Shifting the focus from opioids to life beyond pain: A Q&A with pain expert Beth Darnall

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Deaths from prescription painkillers and opioids in the United States have reached epidemic proportions in recent years. Stanford pain psychologist Beth Darnall, PhD, has seen this firsthand in her work with chronic pain patients, and she sees a better way to treat pain. Her research and clinical work focuses on using evidence-based psychology to empower chronic pain sufferers to gain control over their pain.

In a recent Q&A, I spoke with Darnall about her new book, The Opioid-Free Pain Relief Kit: 10 Simple Steps to Ease Your Pain, which includes a free meditation CD designed specifically for pain and practical steps patients can use to target the daily choices, thoughts and emotions that can worsen pain. A sampling:

What are the best tools you’ve found to reduce pain without opioids?

While the term “painkiller” is common, it’s a misnomer when applied to opioids for chronic pain. Studies show that when used long-term, on average, opioids only reduce pain by about 25-30 percent. It’s critical that other strategies be used by patients to gain relief. Brain-training therapies, such as cognitive-behavioral therapy, mindfulness-based stress reduction, and meditation have similar pain-relieving effects, with none of the side effects. By learning techniques that reduce attention to pain — and distress about pain — pain is relieved. It’s not just about teaching patients how to cope with their pain — the techniques actually reduce pain processing in the nervous system, thereby directly reducing its intensity and impact. Think of it as mind-body medicine.

Learning how to calm one’s own nervous system is a critical aspect of pain management. It’s vitally important to learn and use skills to control the cognitive, emotional and physiological factors that amplify pain. Even if opioids are prescribed, they should be just one part of an overall, comprehensive pain care plan that includes pain psychology, self-management, movement therapy or appropriate exercise, and other disciplines.

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How does the mind impact pain?

The mind has a tremendous influence on the experience of pain. Multiple fMRI studies show that focusing on pain or ruminating on it can cause it to worsen. Rumination is one aspect of pain catastrophizing — when a person focuses on pain, magnifies it and feels helpless. The good news is that pain catastrophizing is treatable, and this is the focus of much of my NIH research. It’s an important therapeutic target because catastrophizing is linked to the development of chronic pain after surgery or an episode of acute pain. I teach my patients that even though they have a diagnosed medical condition, they are participating with their pain through their choices, thoughts and emotions. While we can’t change the medical diagnosis, we can target daily choices, thoughts and emotions to gain control and change the trajectory of pain.

Previously: Chronic pain is correlated with major depression – for sufferer and spouse , study finds, Computer-based program helps physicians monitor and treat chronic pain more effectively"People are looking for better answers": A conversation about chronic pain and Stanford expert on back pain: "The important thing for people to know is that it's treatable"
Photo by Ian Mackey

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