A Conversation About Chronic Pain

Over 100 million people suffer from chronic pain in the United States–and that number is increasing. We have begun a series of conversations with leaders in the chronic pain world about what’s happening today. Stanford University psychologist Beth Darnall writes for Psychology Today and last year published a book on chronic pain entitled. Less Pain Fewer Pills. She agreed to answer a few questions for the National Pain Report:

National Pain Report: “How would you characterize the state of pain management today?”

Beth Darnall: “It’s improving but we have a long way to go. We need better pain education for all involved: patients, clinicians, payers. Good education is a foundation for discerning the best choices regarding pain management, and ideally it informs policy. However, even when people have the right education, they may not have the local specialized pain care that will best treat their pain. We need to provide patients and clinicians with better access to pain treatments that promote patient engagement and self-management as these will empower patients.

“For many patients the biggest barrier to specialized pain care is poor insurance coverage, particularly for options that do not involve pharmaceuticals. As an example, I see many patients who understand the benefit of pain psychology, would love to access this service, and even have a local provider in mind but have no insurance coverage. With pain, there are a series of steps, and if any one does not work, the patient receives suboptimal care. We need more federal dollars earmarked for pain research. Pain is woefully underfunded in health research, despite it being the most prevalent health problem. The National Pain Strategy identifies all of these needs and more, and provides a strategy for addressing these unmet needs.”

National Pain Report: “What impact is the DEA’s emphasis on reducing pain med usage having on the provider and the patient? There are some who feel the government has gone too far.”

Beth Darnall: “It is highly unusual to have the DEA involved in medicine, so this was bound to create disturbance for patients and prescribers alike. Some regional and national data suggest that there has been a leveling off of opioid prescribing in reaction to restrictive prescribing guidelines. Anecdotally, we are seeing fewer and fewer patients that come to our clinic with existing regimens of very high dose opioids, in the range of several hundred milligrams of morphine equivalents daily. There appears to be greater awareness that high dose opioids are dangerous and should be avoided. There is growing awareness of the dangers of co-prescribing opioids with other medications, such as benzodiazepines. This leads to the next question: How do we treat pain with minimal or no opioids?

National Pain Report: “Another big issue right now is the release of the draft of the National Pain Strategy. You’ve read it—What do you think of it?”

Beth Darnall: “The National Pain Strategy is an excellent proposal that will improve the nation’s assessment, education, treatment and prevention of pain. We need a unified strategy, one that will lead to reduction in suffering for millions. I was truly impressed with the emphasis on improving access to psycho-behavioral pain care and self-management as I believe these will have a major impact on pain reduction and prevention.”

National Pain Report: It’s important for those who drafted it to hear from the pain patient and their families, right?

Beth Darnall: “There is an open commentary phase now, and it’s always helpful for people to make their opinions known. Write letters to your representatives and let them know that pain needs to be a priority in health policy decision making, research funding, and education efforts.”

Editor’s Note: Persons and organizations have until May 20to comment on the NIH “National Pain Strategy”. You can do so online (click here)