Dr. Beth Darnall: Less Pain, Fewer Pills

Welcome to Episode #11 of the Healing Pain Podcast with Dr. Beth Darnall!

Today we are joined by Dr. Beth Darnall, PhD

Is it possible to avoid the dangers of prescription opioids and gain control over chronic pain? In the past few decades there has been an alarming trend of using prescription opioids to treat chronic pain. Canada and the U.S. have seen alarming increases in opioid prescribing and in opioid-related overdose deaths. Prince’s tragic opioid-related death further highlights this international public health problem.

Dr. Beth Darnall, PhD joins the Healing Pain Podcast to discuss the pivotal role of pain psychology. On the podcast she discusses the benefits of pain psychology as well as the lack of a national system in place to treat chronic pain. Beth is a clinician, researcher and advocate for those with chronic pain.

In This Episode You Will Learn:

The recent statics around chronic pain and opioids.
A low or no-risk alternative to opioids.
The role of psychology in chronic pain.
The role of emotions in pain.
Why opioids are not a long-term strategy for pain.
Integrated strategies for pain-relief.

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Welcome to The Healing Pain Podcast, I am your host, Dr. Joe Tatta. It’s great to be here with you today. On the podcast today, I have Dr. Beth Darnell. She is a pain psychologist who works at Stanford University, and she’s also an [inaudible 00:00:14] researcher, as well as an author. She’s published two books. The first one is called, Less Pain Fewer Pills. Then, she has a new book coming out in August which is called, The Opiod Free Pain Relief Kit. Make sure to look to for both of those books, but first, make sure to listen to the interview today.

What I really love about Dr. Darnell, is she’s not only a researcher and an expert, but she really has a passion for helping people heal their pain naturally, as well as turning around our chronic pain and chronic opiod epidemic in this country. Dr. Beth Darnell, it’s great to have you here on The Healing Pain Podcast. I’ve been really looking forward to speaking with you this week.

Thanks so much, it’s great to be here, Joe.

Obviously, as a pain expert, a pain psychologist you know that we are in the midst of a chronic pain epidemic. And obviously, an opiod epidemic, as well. I just wanna start off just by talking about opioids, just a little bit. And, really ask you, how did we wind up in this place, where we have so many people that are reliant on opioids to … I don’t want to use the word solve, but they rely on opioids to treat their chronic pain.

Yeah. It’s really a great question. Historically in the United States, opioids weren’t the front line treatment for chronic pain. In the past ten or 15 years, suddenly there was this dramatic increase in prescribing opioids. There’s several reasons why opioids became the go to for chronic pain, whereas in the past they were really just used for cancer pain and end of life. One of the main reasons for the big push for opioids really came from the pharmaceutical industry, there was a lot of marketing put forward that opioids were safe, effective, and non addictive. A lot of false information was put forward to prescribers, to physicians, and to the public, so everyone wanted to believe that there would be a quick and easy solution. But in fact, they aren’t the easy solution that everyone hoped they would be.

Can you give us an idea of how many people actually use an opioid in our country to treat their pain?

Yeah. Recent data in 2012 statistics showed that about 300 million opioid prescriptions were dispensed in the United States. This is enough opioid medication to medicate every single American around the clock, 24 hours, for one full calender month.

Oh my Lord. Every American for an entire month, basically.

Correct. Clearly this is just a staggering statistic. You might think that this is true around the world, but in fact it’s not. Other countries around the world don’t treat chronic pain this same way. The United States … even though we have the same amount of pain as other countries, we’re not unique in the United States. We consume 80% of the world’s supply of opioid medications, and more than 90% of the world’s supply of oxycodone.

Fascinating statistics. Thank you for sharing those. I think it really paints a really good picture about where we currently are. As a pain psychologist, where does psychology fit into the picture and really to help solve chronic pain, where does it fit into the picture?

Yeah, it’s a great question. Most people think of pain as being really centered in the location of the body where they feel the pain, it’s that ouch it’s that hurt, it’s in your back, it’s … wherever it is in your body, we really focus on that localized pain. But in fact, the definition of pain is that it’s a negative sensory and emotional experience. It’s a negative sensory and emotional experience. This definition of pain, which is put forward from the International Association for the Study of Pain, really recognizes that psychology is built into the experience of pain, it’s half of the definition. Interestingly, we don’t treat it as such.

There’s an over focus on the biomedical aspects of pain and there’s not a good appreciation of the role of psychology in pain as being integral to the pain experience. What we can do, as part of the solution, is focus on this whole other half of the definition that is largely ignored. This is where patient empowerment comes into play, because if we can have better control of our … essentially our pain circuitry, then we can have better control over our pain experience. Ultimately, what this leads to is fewer doctors and fewer pills.

You said something interesting that a lot of speakers on my podcast talk about, I talk about as well, is the where we were regarding the biomedical model versus the biopsychosocial model. Those can be big words, so we have clinicians, as well as patients who watch this podcast. Can you talk to us, what is the difference between those two? You first said biomedical, what does biomedical mean?

Yeah, yeah. Biomedical is when we treat a health condition, in this case pain, purely from a medical perspective. We want to look at, what are the pharmaceuticals we can throw at the pain? What are the procedures? Do we give injections? Do we need to do a surgery to solve that pain? We’re looking at it as a purely medical phenomenon and treating as such. What the data tell us, what we really know, is that pain is best treated comprehensively. That is through the biopsychosocial model of pain treatment. So, medical is part of it, that’s the bio part of it. But then, psychological and also the social aspects and dimensions of pain need to be recognized, assessed, and also treated. It turns out that the psychological factors sometimes have much more of an affect on the pain experience, and they can determine whether pain resolves or not. So, treating pain purely from the biomedical perspective is really shortsighted and does a disservice to the patient.

All right. I think it’s really to note that a lot of Physical Therapists and Psychologists teaming up in teams, and they’re really working together to kind of push that biopsychosocial model to the forefront basically. We’re basically saying that for chronic pain, things like X-rays, MRIs, surgery, and medication, really is not the way to solve pain, is that correct?

It’s correct. It’s very limited. The medical piece certainly has it’s role, but it’s just one part of the equation. If we over focus on that one part of the equation, unfortunately we are colluding in the dis empowerment of patients because we are preventing them from understanding that their choices, that their skills, that everything that they do on a daily basis has a much more profound influence on their pain, on their quality of life then those few moments in the doctor’s office or in the pill bottle. So really, what the data tell us is that we have to help patients learn to best help themselves. That’s what leads to the lasting changes.

When you talk about patients helping themselves, we’re really talking about active coping strategies. These are ways that a psychologist or a doctor of physical therapy, or other practitioners may teach you some skills that can empower yourself to really start to heal basically, not when you rely on a passive treatment.

Absolutely. Just as an example, it’s common for individuals with pain to want to minimize their pain experience. So, what do they do? Let’s take back pain as an example. A person has back pain and they notice hen they bend or they move they feel more pain, so what might they do? They might stop moving, they might stop exercising, stop bending. Pretty soon, they’re doing less and less and less. This is called fear avoidance behavior, it’s really natural. Pain is designed to get our attention and shape our behavior so that we move away from it as a way to protect ourselves. It’s very effective in shaping our behavior to get away from pain. Now, the problem is is that overtime people become less and less active, they become de conditioned and then maybe start to develop new pain problems as a result of this.

What we know about chronic pain is that paradoxically some of the best medicine for pain is actually activation, it’s actually appropriate exercise, appropriate movement, it’s getting back into your life and the meaningful activities, the things that you love, in a way that works with your body. So, there’s something with this rehabilitation component to it. But, if we just focus on the pill bottle, we miss this huge aspect of chronic pain treatment. So, what happens then, is that you have people who do less and less, who are on the couch or in the bed, and they’re only taking pills. That will not get them on the road to recovery. That will not get them back to a life that’s meaningful. We want to steer people in this direction of rehabilitation, where they’re enhancing their quality of life, where they’re moving towards better mood, and really moving towards those things that they love and that they miss.

Incredible. I think it’s such a great message that you’ve just given all the listeners and viewers about, what they really need to do to help themselves out. Now, a couple minutes ago, you mentioned emotions. Now, in the course of my 20 years as a physical therapist, I have referred chronic pain patients to pain psychologists quite frequently. The first question they say when I try to help them out that referral is, “Are you telling me that the pain is all in my head?”

Oh, yeah.

How do we get around that, and what do you say to patients when they first come to you and they say, “I was referred by either my physical therapist or my primary care doctor, and they said I should see a psychologist, but to me it seems like this is something only for people with a psychosis, so to speak”?

I know, it’s so unfortunate that there’s so much stigma around the word psychology. I almost wish that we had a different word, like health optimizer, or I don’t know what. But, that’s really what it is. Unfortunately, there’s this association with the word, with psychologist and mental health problem. When in fact, a pain psychologist is really working with an individual to help them live their best life possible within the context of chronic pain, and within the context of often some pretty serious medical conditions. I usually work to dismantle any perception that pain is all in your head, or that it’ the result of a mental illness, it’s not. People have pain. Your pain is real. Your pain has a medical basis. Regardless of all of that, there are things that you can do to reduce your own suffering.

This is the realm of pain psychology, because what we’re looking to do is really … I tell people that their brain is their pain computer and we’re looking to work with the pain computer to make it less sensitive and less reactive to pain. This is learning skills, using certain skills regularly so that a person has better control over these … essentially, these processes that happen in the nervous system. It’s just not well appreciated in our culture that this is the role of pain psychology, but it turns out to be true that our emotions and our thoughts have a profound influence on how much pain we feel, how much suffering we experience, and whether or not our pain gets better or worse. That doesn’t mean that it’s an individual fault, but it does mean that there is a lot of power that’s available to you, if you’re willing to extend yourself and harness that power.

Yeah. I think what’s really important to kind of reiterate, I’ve reiterated before on my podcast, is that pain is really a … it’s function of your brain. Even though you are feeling it in your body, you wouldn’t have pain unless your brain was paying attention to it.

Absolutely. No question about it. All pain is processed in the nervous system, in the brain and in the spinal cord, all of it, no matter where you feel it in your body. It turns out that the brain and the spinal cord are also exquisitely attuned to a lot of other factors. Your nervous system is attuned to stress. Your nervous system is attuned to your emotions. Your thoughts determine how much amplification occurs in pain processing. We can use skills, pain psychology skills, to decrease this amplification. Now, it’s not gonna cure your medical condition, but it can profoundly decrease this amplification and it can reduce your suffering and your need for medical visits.

Right. So, for example, what you’re really saying is that if you have diabetes, let’s say, a chronic case of diabetes, you’re still gonna have to work on your nutrition to get inflammation down, you’re still gonna have to work with a physical therapist to get some healthy movement into your life, which helps you not only physiologically but also helps desensitize the nervous system, as well. But really, to work at someone like you, who can start to make these really deep connections, these kind of profound connections, to have the brain influences … everything I just spoke about, really can be the one thing that sets people on their path to healing.

I think people will be very surprised to learn how much control actually exists. Very specifically, directly going in and working with your pain computer to decrease the impact of thoughts, choices, stress, and … my personal belief is that this is relevant to all of us, it’s not just that some people should work with a pain psychologist, I believe that all of us should learn and use these skills because, again, it’s where out power lies in really improving our own health and our own experience.

Yeah. Really powerful. So, you have a private practice in California I believe, is that correct?

Well, actually I’m a psychologist at the Stanford Pain Management Center, so I work as one part of an interdisciplinary team. That includes pain physicians, physical therapists, acupuncture, occupational therapy, nutrition. We treat the whole person, not just the body part.

What could someone expect when they come to see you? What kind of … articulate for us like a typical treatment session. I know you have some really great things going on in your practice.

Yeah. That is a great question, ’cause a lot of people wonder, “What happens in a pain psychology evaluation?” I really take a look at the whole person. How are they sleeping? What medications are they taking? What’s their daily schedule like? What’s their history? Certainly, because we know that certain … if a person experienced trauma or abuse as a child and that has not been addressed or treated, that can lead to amplification of pain, even in adulthood. So, it’s very important to treat some of these, even remote factors that could be impacting a person’s experience in the day to day now. I look a lot at the here and now. What’s a person’s sleep schedule? How are they doing with that? And again, what kind of medications are they taking because something like opioids … some people think, “Well, I’m taking opioids and they help me sleep.” What we actually know is that opioids disrupt sleep architecture. What that means is that they prevent us from achieving those deeper stages of sleep that actually are restorative.

So, taking a look at the whole person, not only where are the problems. How much fatigue do they have? But then, working backwards. What are the contributors to that problem? So, a person may have a lot of fatigue and then I come to find out, well they’re not sleeping well. Well, they’re also taking opioid medication which is contributing to fatigue. They’re also not exercising, and if we improve that that can help with fatigue. It’s really kind of taking a look at the whole person and finding opportunities to improve their quality of life by putting their choices and really putting their choices under the microscope. And also, determining what kind of skills are they using on a daily basis to help manage pain and stress. Most people have a lot of room for improvement in that area. We’re born knowing how to get away from pain, we’re not born knowing intuitively how to manage pain best. These are learned skills. So, almost everyone who I evaluate who comes in, there’s room for improvement there. I really enjoy working with people to help in that way.

Excellent. One of the things I try to be mindful as I talk about chronic pain, and I talk about opioids … ’cause I don’t want to instill more fear in people, because the CDC, the Center for Disease Control, and the NIH, came out a couple months ago with a kind of big statement saying that really opioids are not a good treatment for chronic pain. However, we have had a medical system that has relied on certain types of treatments, but the type of treatments that they’re recommending, things like psychology, physical therapy, nutrition, really they’re not covered well.

A lot of physicians or primary care practitioners, are not really educated about them as far as being interventions. I always try to be an advocate for people and pain, as well. To say that, we made some really good progress the past couple months, but we also need to, as well as treating one on one and helping them, I think all of us as professionals have a job to really advocate for people, as well.

Now, it’s an excellent point, Joe. I recently published an article in the Huffington Post and the title of the article is Opioid Limits Alone is Not a Sustainable Pain Care Plan. The CDC opioid prescribing guidelines recommended reduction in prescribing of the opioids for chronic pain. But, we, as a nation, we can’t just take something away, we have to give people something. Fundamentally, we need to treat pain better, in this country. We have not done a good job at giving physicians, and prescribers, and patients access to the treatments that we know work well. Fundamentally, as a nation, we need to invest in creating policies, treatment pathways, insurance needs to reimburse for these comprehensive treatments. We need to better train all healthcare professionals in this comprehensive biopsychosocial model for pain treatment so that then we’re no longer … physicians aren’t faced with patients coming to them and saying within a 15 minute visit, “You need to solve my pain”, because it’s not gonna happen. Pain isn’t solved in 15 minutes, as we all know.

Excellent point. I really couldn’t have said it better myself. I think really, educating the practitioners out there, as well as the public, about the options and kinda opening those doors and those pathways to people like you and I, are really really important. I know you wrote one book, and now you’re really close to publishing your second book. Congratulations.

Thank you.

To help turn the pain epidemic around. Can you tell us about your second book that’s coming out?

Yeah. My first book was Less Pain Fewer Pills: Avoid the Dangers of Prescription Opioids and Gain Control Over Chronic Pain. The book that’s coming out in two weeks is The Opioid Free Pain Relief Kit: 10 Simple Steps to Ease Your Pain. This second book, the one that’s coming out very soon, is really hands on practical application of some basic pain psychology information and skills that the everyday individual living with chronic pain can begin applying so that they can start retraining their brain and their body away from pain and towards a calmer, more comfortable, happier state of being. It’s really meant to guide individual to best control their own experience.

Excellent. So, can you give us the publication date again, and I’m sorry, the name of the book?

Yeah. It’s actually available for pre order now, at the Bull Publishing website. If you go on Amazon and if you look for The Opioid Pain Relief Kit, it’s gonna pop right up. The actual publication date, it’s available September 1, but we are taking pre orders at Bull Publishing now.

Excellent. It’s been a great interview today. If people wanna learn more about, and follow you and some of your work, and the books you have and other tools, where can they find you?

Yeah. I’m pretty easy to find on the internet, bethdarnell.com. Almost, any way you spell it, you will be directed to my website. It’s really the best way to learn information. I have videos, free articles, information, it’s kinda one stop shopping for learning more about what I do and also about the field in general.

Excellent. Please check out Dr. Beth Darnell on her website and look out for her new book that’s coming out in two weeks, it’s available for pre order. It’s been great to have her on The Healing Pain Podcast today. I want to thank her. Please stay connected each week at doctorjoetatta.com for The Healing Pain Podcast, and we’ll see you next week.

Thank you, Joe.

About Dr. Beth Darnall, PhD

Beth Darnall is Clinical Associate Professor in the Division of Pain Medicine at Stanford University. A pain psychologist, she has treated patients with chronic pain for 15 years. She serves on the boards of directors for several national pain organizations, editorial boards, is a section editor for Pain Medicine, and served as the 2012 President of the Pain Society of Oregon.

Her research — conducted mainly on women with chronic pain — includes investigations of pain catastrophizing and its impact on neural functioning, the immune system, and sensory perception. She is focused on broadening access to low-cost, high-quality pain psychology treatments. She is currently studying how optimizing psychology prior to breast cancer surgery may improve pain and recovery in women.

She serves as the primary investigator on more than $5 million in NIH funding. She is currently investigating mechanisms of catastrophizing and the single-session catastrophizing treatment she developed.

She is Co-Chair of the American Academy of Pain Medicine’s Task Force on Pain Psychology, and in 2015 received a Presidential Commendation from the American Academy of Pain Medicine.

Her main passion is empowering people with chronic pain to harness the power of their mind-body connection to reduce symptoms and optimize health. She is author of Less Pain, Fewer Pills: Avoid the Dangers of Prescription Opioids and Gain Control Over Chronic Pain © 2014 and The Opioid-Free Pain Relief Kit © 2016.

To learn more about Dr. Darnall visit www.bethdarnall.com.

Don’t miss the next episode of the Healing Pain Podcast!

The Healing Pain Podcast features expert interviews and serves as:

A community for both practitioners and seekers of health.
A free resource describing the least invasive, non-pharmacologic methods to heal pain.
A resource for safe alternatives to long-term opioid use and addiction.
A catalyst to broaden the conversation around chronic pain emphasizing biopsychosocial treatments.
A platform to discuss pain treatment, research and advocacy.

If you would like to appear in an episode of The Healing Pain Podcast or know someone with an incredible story of overcoming pain contact Dr. Joe Tatta at [email protected]. Experts from the fields of medicine, physical therapy, chiropractic, nutrition, psychology, spirituality, personal development and more are welcome.

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