LAS VEGAS—Catastrophizing is known to worsen pain levels perceived by patients and is one the key factors underlying the transition from acute to chronic pain.
During PainWeek 2016, Beth Darnall, PhD, clinical associate professor at Stanford University School of Medicine and Clinical Pain Advisor board member, detailed the approach she developed for the efficient management of pain catastrophizing.1
Dr Darnall treats psychological factors associated with catastrophizing over multiple sessions, which she synthesized into a 2-hour class of compressed pain psychology. This method was pilot-tested in the clinic at Stanford in “real-world patients with chronic pain of mixed etiology.”
Pain catastrophizing was significantly reduced by this simple 2-hour psycho-educational class, as evidenced by large treatment effects that Dr Darnall and her colleagues at Stanford University observed. A randomized clinical trial to study the efficacy and mechanism of this catastrophizing treatment is underway.
There are no treatments currently available for pain catastrophizing and “outside of the pharmacology, our approach on preventing chronic pain is in its infancy,” said Dr Darnall. This lack of resources prevents patients from achieving optimal outcome, pain-wise following surgery.
Dr Darnall adapted the compressed pain psychology program to the surgical setting; this approach is currently tested at Stanford in women undergoing surgery for breast cancer. She and her colleagues seek to determine whether this treatment will teach patients to self-treat and calm themselves prior to and following surgery.
“These are the types of solutions that we need going forward,” she added. These online and free of charge resources are of particular interest to patients living in rural settings and who may not have access to pain psychologists.
Another resource used at Stanford University is the Collaborative Health Outcomes Information Registry (CHOIR), which is leveraged to identify patients likely to catastrophize before surgery. Those patients are sent a link for this pain psychology treatment, with the goal of improving post-surgical outcomes and preventing the development of chronic pain.
According to Dr Darnall, these tools can teach patients critical skills that will allow them to dampen pain processing in their nervous system and get more engaged and active in their care. One of her main goals is to “optimize patients’ skills and information as a way to minimize opioid [prescribing and use].”
“What we need to get there is an emphasis on biopsychosocial [approaches], pain education for all healthcare providers, and fundamentally, we have to equip physicians with the resources to treat pain better,” added Dr Darnall.
“We have done a disservice to physicians and prescribers in the United States; they have not received adequate training,” she said. According to a National Needs Assessment survey that gathered feedback from 2,000 individuals across 6 key stakeholder groups -with 1,000 patients, hundreds of mental health therapists and psychologists, pain physicians, primary care physicians, physician assistants and nurse practitioners- individuals do not know how to find a qualified pain psychologist.2 This is what Dr Darnall seeks to change.
- Beth Darnall, PhD; Sean C. Mackey, MD, PhD. In the Wake of the CDC Opioid Guidelines and the National Pain Strategy: Leveraging Pain Psychology and Platforms to Address the National Pain and Opioid Crises. Presented at: PainWeek 2016. Las Vegas, NV; September 6-10, 2016.
- Darnall BD, Scheman J, Davin S, et al. Pain Psychology: A Global Needs Assessment and National Call to Action. Pain Med. 2016;17(2):250-263.