Welcome to the inaugural newsletter of the American Association of Pain Psychology (AAPP).
My name is Kimeron Hardin, PhD, ABPP and I was both honored and excited to be asked to write the first newsletter by the AAPP steering committee. Our goal is to provide cutting-edge, provocative content in pain psychology, helping you stay current and connected to our organization.
The format will be simple and conversational, and will include news, perspectives, successes and controversies related to the effective and ethical practice of pain psychology. Our plan is to have rotating newsletter authors who will bring their own unique experiences to their posts as well as evidence-based information, allowing us to bring you interesting content and a broad array of voices.
To start us off, I thought I might begin with a reflection on pain management as a medical and psychological specialty.
Pain management is actually a relatively new medical specialty in the history of Western medical practice. What began as part of the traditional biomedical model, with physicians at the helm, in the late 20th century, has now necessarily become a biopsychosocial treatment model, with various growth spurts and growing pains along the way.
As a novice pain psychologist almost thirty years ago, I was quickly overwhelmed by the demands and limits of the field and my own training. At the time, there was really no such thing as a “pain psychologist” with expertise and training in the psychology of pain, only psychologists who applied their intensely-focused but general behavioral knowledge on people living with pain – a far cry from the integral role pain psychologists play today.
Although my doctoral studies were heavy in CBT and behavioral medicine studies, I had no specific training or education in working with people with pain, and only limited exposure to pain patients during my pre-doctoral medical center internship. It took years of “on-the-job training,” learning from both my medical peers, and more directly from my clients themselves, before I became comfortable with my grasp of the complexity of pain management.
My early referrals from pain physicians were among the most complicated people I had ever seen at that point. Most had been in pain for over a decade and were gripped by fear and depression, as well as a healthy skepticism for a medical system that had betrayed them, harmed them, and ultimately abandoned them.
Those clients often came to me feeling desperate, alone and stigmatized. They resisted the label of “mental illness” and “addict” as long as they could, feeling like they were now admitting that their pain was through some moral failing or mental collapse. Many were shamed by their doctors for failing to get better and most had little hope that the pain would improve or that life could be joyful again.
Thankfully, much has changed over these thirty years.
It has taken years for the practice of pain management to begin to incorporate Melzack and Wall’s pivotal early work on the Gate Control Theory, and subsequent important iterations, into medical practices. Finally, emotions, thoughts, perceptions, context, and social support are acknowledged as critical components both of pain and its management. Fueled by innovative technologies – like functional MRI studies of the brain in pain – and spiraling costs of aggressive, but ultimately unhelpful medical interventions, pain psychology has begun to rightly take a prime seat at the multidisciplinary treatment table. Now, pain psychology is often introduced to patients much earlier in the treatment process. It is not uncommon for me to receive referrals of patients whose initial injuries or pain onset was just weeks or months prior, a great change from the decade-plus my patients waited for help in the past.
Today, we support our patients with their emotional response and adaptation to pain. There is also finally recognition that psychosocial interventions such as CBT, mindfulness, pain education, and other interventions effectively reduce pain itself by changing the brain. New frontiers in neuroscience are exploring novel ways of reducing or even reversing centralization of pain – a concept not even considered to be a realistic hope until recent years.
It has become clear just how limited the traditional biomedical model is for pain relief. The US opiate crisis, fueled by political and economic factors that have historically trumped and muted sound science and practice, has brought a laser focus to the limitations of a biology-only approach to pain. Pain clinics practicing from a medical-only perspective now are rushing to change, or risk collapse. Practices built solely on prescriptions and procedures are now reaching out to pain psychology and rehabilitation professionals in record numbers. AAPP regularly receives and broadcasts pain psychology job postings. Insurance companies are begging for ways to identify competent pain psychology professionals who can assess patients.
As much as things have changed, however, many things sadly remain the same.
Comprehensive education and training for mental health professionals in pain management is still sorely lacking. In 2016, Dr. Beth Darnall – pain psychologist, researcher at Stanford’s Neuroscience and Pain Laboratory, and AAPP member! – and colleagues published the results of a global needs assessment for pain psychology in the Journal of Pain Medicine. According to the survey1 of over 1900 psychologists and other therapists, pain patients, medical professionals, and directors of training programs, there is both low confidence and low perceived competency to address physical pain, and a high need for pain education. Primary barriers to pain psychology include lack of a system to identify qualified therapists, paucity of therapists with adequate pain training, limited awareness of the psychological treatment modality, and poor insurance coverage.
Our organization, the American Association of Pain Psychology, arose out of a recognition that current academic and training experiences were often sorely inadequate (pun intended) to prepare mental health professionals to work effectively with people living with chronic pain. Over the past ten or so years, AAPP has attempted to provide high quality, educational opportunities to the pain management community. We have now expanded beyond offering programs solely to therapists, and now offer trainings for all biopsychosocial pain providers across disciplines, including physicians, nurses, physical therapists, occupational therapists, biofeedback providers, mindfulness practitioners, and other integrative providers.
We currently provide live workshops in the Bay Area several times a year, bringing in expert presenters on subjects ranging from opioids to somatic pain treatments to models of care in pediatric pain. Soon, we will offer APA-accredited, online educational opportunities for our national members, and we hope to soon play a pivotal role in helping academic training programs incorporate pain psychology into their curriculums.
AAPP has many exciting frontiers to conquer. With your help, your energy and your involvement, we can improve the lives of many. Please let us know if you have a topic that you’d like to see us include in the blog. We are open to feedback and input! Please consider joining our group via this link. Our members keep us strong and vital, and we are stronger together.
Thank you, come again and stay in touch!
1Beth D. Darnall, Judith Scheman, Sara Davin, John W. Burns, Jennifer L. Murphy, Anna C. Wilson, Robert D. Kerns, Sean C. Mackey, Pain Psychology: A Global Needs Assessment and National Call to Action, Pain Medicine, Volume 17, Issue 2, February 2016, Pages 250–263, https://doi.org/10.1093/pm/pnv095