Patient Psychology Called Key in Pain Management.
“Pain is fundamentally more than just biology,” says Beth Darnall of Stanford
Pain is treated solely as a biomedical problem too often, a noted pain expert said here.
“Pain is commonly thought of as being purely a sensory experience,” said Beth Darnall, Ph.D., of Stanford University School of Medicine, at an educational session at the PAINWeek 2018 conference.
“But psychology is built into the definition of pain as a negative sensory and emotional experience. Pain is fundamentally more than just biology.”
This definition stands as a testament to what Darnall says works best for treating pain: a comprehensive approach. “When psychological structures are integrated into pain care pathways, patients do better,” she said in an interview with MedPage Today.
“In our culture, we get into binary thinking about medications, psychological treatment, and non-pharmacological treatment. But it’s the integration of treatment that serves a lot of patients well.”
Recent research has shown that cognitive behavioral therapy can reduce pain scores and that integrating pain education into treatment can lead to better long-term outcomes, for example.
While opioids can be very useful in treating chronic pain, “they should never be the front-line agent,” Darnall said. “We can provide people with a range of treatments and strategies so they are not focusing on any one thing. This is where psychological approaches come in.”
Perhaps the most important thing primary care clinicians can do is to introduce the concept of self-management and behavioral medicine strategies “as early as possible in the conversation with patients, preferably on day one.”
“They can begin plugging their patients into self-management strategies, even if it’s online strategies, books, or other information, so patients can begin learning what they can do on a daily basis to help themselves best manage pain.”
This is not to the exclusion of medical approaches, she noted: “We simply want to empower patients to make the right choices so they need fewer doctors in the long run.”
The American Chronic Pain Association has resources for patients and clinicians, she pointed out. “Primary care clinicians can help patients use educational materials so they can learn more about how they can help themselves.”
If integrated pain management is addressed early, it gives patients a different context for understanding how pain is treated. “Unfortunately, what happens is that we focus on the medical procedures and prescriptions and when those don’t work well after everything else has failed, that’s when we introduce other strategies,” she observed.
“It’s demoralizing to patients because they encode it as ‘well, there’s nothing left to help me.’ They feel blamed and abandoned, but all this is preventable if we simply introduce other strategies upfront.”
“Engaging the patient as an active participant in their pain care is the secret to improvements,” Darnall noted. “Everybody wins when integration occurs early on.”
Darnall disclosed advisory relationships with Axial Healthcare, Clinical Pain Advisor, Pacira, and appliedVR. She also is the author of several books about pain.