Humans, like other animals, are born with an instinctive motivation to escape pain. Think about the last time you touched something painfully hot and how quickly you pulled away from it. Your quick and automatic action is the result of hardwired biology meant to preserve your health and survival. When it comes to ongoing, severe pain that comes from within your own body—migraine or back pain, for example—escape isn’t so easy. About 100 million Americans experience this kind of chronic agony, making it more prevalent than diabetes, heart disease and cancer combined—and it has a significant impact on their lives.
Medication is one answer, but painkillers such as opioids—and even drugs like ibuprofen and acetaminophen (more familiar to some as the brands Advil and Tylenol)—can have significant downsides. It turns out, however, psychological approaches such as cognitive behavioral therapy (CBT) can help you train your brain away from pain. Brain-imaging research has shown a negative pain mind-set (ruminating on how awful pain is and expecting it to worsen) actually amplifies pain processing in the brain. Using low-risk CBT techniques over the course of several weeks, however, alters brain structure. It learns to ratchet down pain signals, which enhances the effectiveness of medical interventions and helps patients reduce their need for doctors and pills.
Here’s how it works:
—Training the brain away from pain. CBT is a skills- and evidence-based psychological treatment for chronic pain. Brain-imaging research has shown pain CBT effectively treats a negative pain mind-set. Patients learn how to help steer their minds away from negative or “catastrophic” patterns of thought—such as “my pain is awful and there’s nothing I can do about it.” Instead, they’re taught to replace these with supportive and soothing thoughts such as “this pain flare is temporary; I’m going to focus on good self-care." Daily relaxation of mind and body cultivate a sense of safety that counteracts the ingrained danger signal of chronic pain. Brain-imaging studies show that after 11 weeks of group CBT, patients report less pain, greater control over their experiences, less catastrophic thinking about pain and, importantly, increased volume in the regions of the brain associated with pain control.
—Getting to empowered pain relief. Of course, access to group pain-CBT or to a pain psychology expert may be poor. To address this unmet need, my team and I are focused on developing and investigating brief pain relief mind-set interventions that can be delivered in large groups or even online. For instance, I developed a targeted two-hour pain relief mind-set class for patients with chronic pain so they can learn key information and skills to help themselves in a single session. The class includes pain education—self-treatment pain relief skills that help patients better control factors that amplify pain. Our current clinical trial on this single-session pain relief class is funded by the National Center for Complementary and Integrative Health (NCCIH).
—Applying mind-set science to prevent postsurgical pain. Roughly 10 percent of surgical patients develop chronic pain after surgery, and for some surgeries the rate is closer to 35 percent. Negative pain mind-set is a leading factor in the development of chronic pain after surgery and prolonged use of opioids. I created “My Surgical Success,” a fully automated, online pain relief and recovery mind-set program that at-risk patients can access before surgery in the comfort of their own homes. We have tested My Surgical Success in women receiving surgery for breast cancer at Stanford Hospital and Clinics and are now conducting studies in orthopedic trauma surgery patients to learn whether it can reduce postsurgical pain and opioid use.
—Applying mind-set science for opioid reduction. Research suggests more than 6 percent of the U.S. population is taking long-term opioid prescriptions. Patients report their main concern about reducing opioids is fear of worsening pain—and these fears are often increased with forced tapering of the dosage. Our latest research suggests partnering with patients so they voluntarily agree to a slow opioid taper helps them successfully reduce their opioids without increased pain. These exciting results are challenging common beliefs about opioids and pain held by prescribers and patients alike, and suggest a pathway to help patients comfortably reduce their health risks.
Recently my team and I received an almost $9-million award from the Patient-Centered Outcomes Research Institute (PCORI) to apply our techniques to reduce opioid use and associated risks, and to treat pain better using patient-empowering psychological strategies. (We are testing this in over 1,000 patients taking long term opioids.)
In this project we aim to shift mind-sets about opioid reduction from “nocebo” (expectation of worse pain) to placebo (expectation of pain control and good outcome). By addressing negative pain mind-set factors, and by equipping patients with information and skills to best control their pain and suffering, we aim to help them alter their biology and shape their brains toward low-risk pain relief. I am excited by the challenge to connect patients—and the public—to this low-cost health information that can literally change lives.