When I spoke with Stanford Medicine pain psychologist Beth Darnall, PhD, for this 1:2:1 podcast, she told me that what often gets lost in the national discussion about opioids is "how we treat pain and at the lowest risk.” She's written a new book on the topic, Psychological Treatments for Patients with Chronic Pain, that my colleague Tracie White wrote about in the late summer.
Although the book was published by the American Psychological Association and is geared primarily towards mental health practitioners, Darnall thinks there’s a much wider audience. After all, physicians, especially primary care physicians, are often confronted with patients experiencing extreme pain and are at a loss at how to treat them.
“Many primary care physicians receive very little pain training in medical school, up to 11 hours of pain training, whereas veterinarians will receive 28 hours of pain training," she told me. "There’s a dearth of information, knowledge and, importantly, resources to treat pain. It’s unsurprising why at least, in part, there has been an emphasis on opioids for treatment over the past 15 years.”
Darnall has been working with patients in the field of pain management for 15 years. Helping people understand their pain, she says, starts with a broad multidimensional evaluation: “I’m going to assess your sleep, your physical activity, your functioning, your mood, how well you’re functioning socially. I’m going to identify opportunities to help you improve across a whole range of domains in your life.”
Darnall thinks that there's too much focus on pain intensity and the numeric pain score. “'What’s your pain score?' There’s so much focus on that number. When we stop focusing so much on the pain number, and start focusing on doing more with family, moving towards valued goals, sleeping better, wellness activities, getting active, movement on a daily basis - that turns out to improve one’s life. Curiously... a reduction in pain seems to follow along.”
So what does Darnall want health care providers to take away from the book? “I’m on a mission to help have psychology be integrated as primary pain treatment – not to the exclusion of medical treatment and traditional approaches but [with] equal footing alongside those treatments," she said.
Photo by Ian Mackey