Ask Dr. Beth, Pain Psychologist

Dr. Beth Darnall

Editor’s Note: National Pain Report is pleased to welcome Beth Darnall as our newest columnist. Beth is a pain psychologist and clinical associate professor in the Division of Pain Medicine at Stanford University School of Medicine. She has a particular interest in women’s pain issues.

Beth will be answering questions from readers about chronic pain and pain management.

Send your questions to AskDoctorBeth@nationalpainreport.com.

Why is it that women suffer from chronic pain more than men?

Dr. Beth: Many chronic pain conditions, such as autoimmune conditions, migraine and fibromyalgia, are up to 10 times more common in women. So women are simply more likely to acquire chronic pain than men.

Once women have chronic pain, they suffer more from it than men. Research shows women experience pain more frequently, severely, and for a longer duration than men do.

There are many reasons why women have more pain than men. Sex/gender differences in hormones, pain processing, and psychological factors known to influence pain (such as cognition, anxiety, depression and history of abuse) are just a few known reasons.

Pain becomes more common as we age and menopause is known to worsen chronic pain due to hormonal changes. Also, women live longer than men and thus have more years of life to experience pain!

There is growing need to better understand pain in women and how to best treat it. I believe the future of the field of pain medicine is sex-specific pain treatment (medical and psychological). I look forward to contributing to this field. At a minimum, we can say that the benefits, risks, and consequences of pain and pain treatments are greater for women simply because they are more affected by pain.

I’ve had some difficulty finding the right pain physician who will really listen to me. Any tips on how to find a good one?

Dr. Beth: I recommend two things. First, do your own online research. Look for webpages that contain profiles about the physician you are considering. Be sure that the physician mentions an interest or specialty in either chronic pain or women.

Second, ask around. Ask any medical professionals you trust or any friends you trust. Perhaps your insurance does not provide coverage for pain psychology, but you could still contact a good pain psychologist and ask them if they have recommendations for good primary care physicians.

I see news stories all the time about the evils of pain medication. My pain is unbearable at times and I can’t imagine living without pain medication. What is a patient to do?

Dr. Beth: The popular press mainly talks about opioid medication and the problems associated with opioids. But there are many types of non-opioid pain medication. For instance, gabapentin is a non-opioid medication used to treat neuropathic pain, and it has fewer risks than opioids. I recommend seeing a pain physician specialist so they can optimize your non-opioid pain medications or help you consider alternative approaches, such as acupuncture, pain psychology, physical therapy, and chiropractic.

Opioids are not evil, but they do have consequences when used long term to treat chronic pain. It is important that you know exactly what those consequences are. For instance, long term opioid use can lower estrogen, DHEA (Dehydroepiandrosterone) and testosterone in women. In women of childbearing age, this may affect your fertility, at least temporarily.

For all women — even post-menopausal women — hormonal changes may negatively impact pain, energy, and mood. Pregnant and breastfeeding women need to understand the risks to the fetus and/or infant. If you understand which risks are relevant, you may make an informed choice about whether you wish to stop opioids, avoid starting opioids, or simply minimize opioid use.

Everyone can agree that it is best to use as little opioid medication as possible; they are not vitamins and can have negative consequences. Learn as much as possible about the medications so you know about the risks and what to do about them.

I realized patients need more information about opioids and a roadmap to use less medication. I wrote a book for patients on this topic and it will be published in 2014 (Bull Publishing). In the meantime, anything you do that helps you calm mind and body will help reduce your pain and your need for pain medication.

Dr. Beth Darnall treats patients at the Stanford Pain Management Center in Redwood City, CA. More information about her can be found here and here.

Have a question for Dr. Beth? Send them to AskDoctorBeth@nationalpainreport.com.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that! It is for informational purposes only and represent the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

For more information, read our User Agreement and Terms of Use.