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Stanford University School of Medicine

Is pain in the brain? A pain psychologist discusses alternative to opioids

darnallA few years ago, I began experiencing significant pain. It emanated from my rotator cuff and spiraled down my right arm. It was sharp, persistent and bothersome. Years of swimming laps and the repetitive motion of turning my neck to breathe on one side caught up with me; I rarely stretched my upper body, thus my journey into pain began.

Not having experienced this type of pain before, I became absorbed in it. Thoughts about pain consumed my head day and night. I never took pain medication to resolve the issue but at one point I was feeling so desperate I would have done virtually anything to make it stop. It was the first time in my life I had felt severe consistent pain, and I worried it would never go away. In the end, some simple steps altered it -- but to this day, I still remember, vividly, how much and how often I thought about, considered and was consumed with my pain. It's no mystery to me why someone in a similar situation would want opioids.

Rarely does a day go by that there isn't a news article about America's epidemic opioid crisis. The statistics are crushingly sad. According to government data (link to .pdf), more people died from overdoses in 2014 than in any year on record, and the majority of those overdose death involved an opioid. Alarmingly, on an average day in the U.S. more than 650,000 opioid prescriptions are dispensed. While pain medication can be used effectively for treating acute pain, many pain experts believe their long term use is not only counterproductive but greatly harmful.

So what are the alternatives to opioids for people in pain? Stanford Medicine pain psychologist Beth Darnall, PhD, offers up a treatment plan for pain relief focusing on self-help and cognitive behavioral principles. She understands from a clinical view what I came to learn experientially: Pain is mainly in the brain. The body's "harm alarm," she writes in her new book, The Opioid-Free Pain Relief Kit, is... "just like a fire alarm warning you of the danger... Your brain and your body work together to prepare you for a fast getaway. A significant part of chronic pain relief involves calming your nervous system -- and quieting your pain alarm." Mind body training, she writes, is an antidote to the body's pain alarm system.

Darnall knows the experience of pain personally. As a child she had pain that was never treated. Later, at 19, tragedy struck someone close to her and thriving pain returned. She was on Vicodin for 6 months before she realized meds weren't the solution. It was then that she began to understand and integrate the connection between mind and body.

For my latest 1:2:1 podcast, I spoke with Darnall about the science of pain management and her practice with patients in the clinic.  She knows from her years treating patients and her own experience that there are alternatives to opioids.

Previously: Shifting the focus from opioids to life beyond pain: A Q&A with pain expert Beth Darnall, "People are looking for better answers": A conversation about chronic pain and Chronic pain: Getting your head around it
Photo by Ian Mackey

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