I had the chance to talk to Beth Darnall, Ph.D., the author of the book, Less Pain, Fewer Pills; Avoid the Dangers of Prescription Opioids and Gain Control Over Chronic Pain (Bull Publishing, 2014). We discussed the tragic epidemic of opioid dependency in the U.S., and the remarkably effective techniques patients can learn to reduce their pain and take less pills.
We’ve certainly seen an explosion of opiate use in this country in the past ten years. What would you say caused it?
It’s really a perfect storm of factors. In the mid-90s, the FDA approved opioids for the treatment of all types of chronic pain. Before that, long-term opioids had been reserved for cancer and end-of-life pain. So this was nothing less than a sea change, signalling to physicians and other prescribers that opioids were both safe and effective. Prescribing opioids for chronic pain started to increase, and kept increasing. Another factor was a simultaneous full-court press by the pharmaceutical industry, who began a massive marketing push. Along the way, some patients (and prescribers) came to believe that they could indeed be pain free if enough opioids were taken. The combination was a recipe for disaster.
What got you interested in the field of psychological pain relief?
I’ve been a pain psychologist for 15 years. I did my clinical internship in a VA hospital, working with veterans who mainly had chronic pain and mental health treatment needs. I loved working with veterans. From there, I did a post-doctoral fellowship at The Johns Hopkins Hospital and treated individuals who had gone though spinal cord injuries, amputations, and catastrophic burns — all of them were in real pain. I discovered that people who were suffering responded well to me. We connected easily, and they were receptive to learning how to help themselves feel better. It’s vitally important that people learn how to help themselves deal with pain. Otherwise, we become fully reliant on medications and doctors — which makes us more anxious, and can lead to using more medication over time.
Do you have a personal connection to the challenge of dealing with chronic pain?
I do: I had chronic pain myself as a youngster and adolescent. Like all chronic pain, stress made my pain worse. During a particularly stressful time in my life, the pain became unmanageable. One day, when I was 19, I walked into the ED (the hospital Emergency Department) looking for answers. Instead of answers, I was given a prescription for Vicodin.
I had no interest in opioid medication. I was looking for answers and a solution to how to deal with the incredible pain I was in. But with no real help given, I took the pills instead, as prescribed. Fortunately, after 6 months, I realized they were not solving anything — and in fact were creating more problems for me. So I weaned myself from them And then I had to learn better ways to manage my pain. I now work to connect patients with the information I so badly needed when I was 19 years old. I didn’t need opioids, I needed pain psychology.
In the book, you talk about “catastrophizing pain,” and how that makes the pain worse. Can you explain that?
Catastrophizing pain is when all you can focus on is the awful pain you’re in. You have trouble focusing on anything else besides how awful and helpless you feel. Everyone catastrophizes from time to time, but it’s important to learn how to stop it so you do not unwittingly make your pain worse.
No matter where you may feel the pain in your body, it’s all located in your nervous system: your brain and spinal cord. Though most people don’t think of it this way, pain is fundamentally a brain-based experience. And the areas of the brain that process emotions overlap with areas of the brain that process physical (sensory) pain.
So pain is not just a matter of sensation, it’s also connected to emotions?
Yes — and that’s one of the reasons why pain is defined as a negative sensory and emotional experience. Negative emotions worsen pain because they serve to amplify pain processing in the nervous system. In studies that use functional magnetic resonance imaging (fMRI), we can actually see this happen. Catastrophizing lights up areas of the brain associated with pain. You might think of it as “growing” pain in the brain. And a persistent pattern of catastrophizing leads to bad outcomes, because your mind is working against you, which can undermine your pain treatments.
Where can chronic pain sufferers find the help they need to gain control of their pain?
Find a pain psychologist or mental health therapist who is skilled in treating pain. Working with someone who has that experience is a great way to gain control of your pain and reduce your reliance on medications. But locating someone may be challenging: in the U.S. there’s a shortage of psychologists and therapists who are pain specialists. Pain clinics located in academic hospitals typically have very skilled pain psychologists as part of their treatment teams. Or, ask your physician, who may know of a good pain psychologist or therapist.
Are there other resources to look into as well?
There are many great pain psychology books and programs out there. I recommend that people read, learn and apply the information and methods they offer. You can work with a general therapist to set pain management goals, and integrate these programs and workbooks into your therapy sessions. Also, it should be noted that treating mental health disorders such depression, anxiety, and post-traumatic stress disorder leads to pain reduction.
What about the connection between stress itself and pain? Are there stress reduction techniques that can?
Pain triggers a stress response in the body: your heart rate increases, you breathing becomes more rapid, your blood vessels constrict, and the muscles tense up. This happens automatically, and it serves to prepare you to escape whatever is ‘causing’ your pain. Now, this is useful in the case of, say, a bee sting or an injury. The stress response allows you to run away and protect yourself. But with chronic pain, you can’t run away. You can’t escape the pain that’s coming from inside you.
The trick is to learn how to stop these automatic stress responses, as they serve to worsen the pain. Evidence-based techniques that work to counter stress and calm the nervous system include diaphragmatic breathing, progressive muscle relaxation, and mindfulness meditation. Since chronic pain can lead to a lot of stressful life changes, such as problems with finances, work, and relationships, it’s even more important to learn how to use these techniques, and then use them regularly. That way you can prevent sudden flareups as well. The result is that you can reduce your need for pain medication, and that’s a very good thing.
Is it a challenge to shift from opioid prescriptions to psychological techniques? Should someone expect to encounter some stumbling blocks along the way?
Many people fall into the trap of believing that a psychological technique doesn’t work because they try it once, and it doesn’t change their pain. But these techniques are not like that first opioid pill you took. It’s better to think of psychological techniques as working more like antidepressants: they build up in your system over a matter of time. It can take weeks.
Similarly to the way you take antidepressants daily to maintain a consistent level of medication in your blood, those daily ‘doses’ of pain psychology skills will change your brain and body. So it’s not about using them just once or twice and expecting a profound shift. Used regularly, pain psychology skills do calm your nervous system, and work to train your brain away from pain. But it’s the consistent use, that ‘daily dose,’ that gains you the results, and allows you to feel better and need less medication.
Find out more about Dr. Beth Darnall at www.bethdarnall.com.