MARCH 2024:   HOWARD ROME, PHD

photo of Howard Rome PhdWhat led you to become a psychologist? What is your educational background?

After initially studying music and sociology, I found my way back to the “family business.” My father, uncle, and brother had careers in mental health, and it gradually dawned on me that I could avoid it for only so long. After relocating from Minnesota to California, I started graduate school at the California School of Professional Psychology. It was a good fit. I was fortunate to get a pre-doctoral internship at California Pacific Medical Center (CPMC) in San Francisco in 1981. The psychiatry/psychology training program at CPMC was superb and exposed me to a number of clinical settings: inpatient, outpatient, neuropsychology, and psychological assessment of chronic pain patients in the Workers’ Compensation system. The rotation that most interested me was the psychiatric consultation/liaison service on the medical wards. Under the supervision of George Becker, MD, an orthopedic surgeon who had trained as a psychiatrist, our team of psychiatric residents and psychology interns evaluated and treated medical inpatients with a wide variety of illnesses that required hospitalization. At this stage of my career, in the early 1980s, HIV/AIDS was just emerging and everyone in the hospital was struggling to understand this new and frightening illness.

What got you interested in pain psychology and what was your experience with health and pain psychology? What were your most significant positions in pain psychology?

On the medical wards, our team was frequently asked to participate in the treatment of patients with severe pain, often when the diagnosis was complicated, uncertain, or when there was concern about addiction. For the large number of AIDS patients referred to us, pain management and end-of-life issues were the focus of our interventions. We provided an array of treatments including medications and injections, psychological treatments including brief psychodynamic and cognitive behavioral therapy, and guided relaxation and hypnosis. Dr. Becker was an excellent teacher and mentor. He led an in-depth seminar on psychological factors in pain and illness and had us read and present articles and books on various topics. We regularly attended weekly orthopedic rounds at CPMC, and this was an invaluable education in medical/surgical issues. With Dr. Becker’s encouragement I chose chronic pain as the topic for my doctoral thesis. The Department of Orthopedics supported my research by referring patients into my MMPI based study on pain and abnormal illness behavior. I subsequently joined the staff at CPMC and remained there for twenty years. My practice focused primarily on medical patients with psychological complications, the majority were patients with chronic pain. For several years I consulted at the Facial Pain Research Center at University of Pacific Dental School. My neuropsychology practice was primarily with the liver transplant team and the geropsychiatry service at CPMC.

I also had the good fortune to work for many years with Elliot Krames, MD. His pioneering work in the neuroscience of pain and interventional pain treatments grounded me in the biopsychosocial model of understanding pain. We worked together to develop multidisciplinary treatments incorporating medical interventions, physical therapy, and cognitive behavioral therapy. My collaboration with Dr. Krames in the ‘80s and ’90s coincided with the emergence of the specialty of pain medicine and of pain psychology as a subspecialty within health psychology. Pain conferences were proliferating. New advances in the basic neuroscience of pain, along with psychological/behavioral research and treatment, were hot topics at these conferences and I learned a great deal. I also learned about the huge amounts of money spent by pharmaceutical and device manufacturers in marketing their pain-related products. OxyContin/Purdue Pharma is, of course, the poster child for what evolved into the most tragic episode in the history of pain treatment. But it follows on from a long history of misunderstanding and mistreatment of pain. Pain is the bane of humankind and chronic pain patients are particularly vulnerable to “misadventures” and exploitation. This is part of the history that we as pain psychologists are well-advised to understand and address.

What has been your most rewarding experience working in pain psychology?

In the late 1990s functional restoration programs for patients with work injuries became the exclusive focus of my practice. With Jacob Rosenberg MD and other pain physicians at IPM Medical Group, I developed and ran a multidisciplinary FRP, and I continue to work there currently on a part-time basis. I also developed practice as a Workers’ Compensation medical-legal evaluator. I’m most comfortable working in a multidisciplinary setting because it feels most in tune with my understanding of chronic pain as having a multifactorial etiology. Addressing all of the components of a complex problem simultaneously through integrated medical, physical therapy, and psychological treatments in a daily intensive outpatient program is, in my view, the gold standard for giving chronic pain patients the best chance to heal and improve, physically and psychologically. This view is supported by outcomes research. With some exceptions, such as Workers’ Compensation in California, and large medical institutions like Kaiser and the Mayo Clinic, intensive multidisciplinary treatment for pain is often not available. Nevertheless, it is still possible to provide integrated treatments in other settings and insurance environments. It requires teamwork and this is where pain psychologists can play a pivotal role in coordinating and communicating with patients, providers, insurance carriers, and families.

What do you feel are your biggest contributions to the field of pain psychology thus far?

The most pleasurable and interesting period in my career occurred when I collaborated with my brother, Jeffrey Rome, MD, a psychiatrist who directed the multidisciplinary pain program at the Mayo Clinic, in writing a paper describing a model for conceptualizing the neurobiologic linkage between pain, stress, and depression. We reviewed the literature on nociception-induced neuroplasticity at the corticolimbic level and proposed a biopsychosocial framework for understanding the sensory/affective/behavioral symptom complex seen in many patients with chronic pain. The paper was published in 2000 and is available online. The title is Limbically Augmented Pain Syndrome (LAPS): Kindling, Corticolimbic Sensitization, and the Convergence of Affective and Sensory Symptoms in Chronic Pain Disorders (search “Limbically Augmented Pain Syndrome” and click on Oxford Academic for full text).

Teaching pain management psychotherapy to psychology graduate students, and providing opportunities for interns to train in our FRP has also been a rewarding part of my career. There are relatively few psychology internships in pain. To grow the field of pain psychology we need more such training opportunities, as well as the leadership of American Association of Pain Psychology in providing continuing education, developing curricula, and gaining recognition for certification in pain psychology.

What advice would you give to people interested in, or just starting out, in pain psychology? How do you anticipate the future development of pain psychology? What is needed to accomplish that?

 Pain psychology is a truly fascinating field, at the forefront of patient care and research for those interested in understanding the mind/body connection. Among the satisfactions of choosing pain psychology as a subspecialty is the opportunity to facilitate and observe very substantial changes in pain severity, physical function, and emotional distress in your patients in a relatively short period of time. It is eye-opening to watch the synergism that occurs when prudent medical treatment is combined with carefully supervised progressive exercise, concurrent training in pain coping skills, and amelioration of comorbid depression/anxiety/anger. It can help even seemingly intractable cases. But please be aware that while we have our remarkable successes, we also have our remarkable failures. Humility is called for, especially in what we promise to our patients about our treatments. This is where the future of pain psychology and pain treatment as a whole lies: in better understanding the complex interactions between pain-induced changes in the CNS and how those changes interface with a person’s psyche, personality, social environment, and the medical/insurance industrial complex. Finally, there are abundant entrepreneurial opportunities for psychologists to link up with like-minded health providers across a variety of specialties to make multidisciplinary treatments available to more people, especially in underserved, underinsured communities.

FEBRUARY 2024:  FRAN STOTT, PHD

Headshot of Fran Stott, PhD

What led you to become a psychologist?

My first career was as a high school English teacher.  I loved the work, and I especially liked teaching high school aged students.  My undergraduate degree was In Literature, and even then I was always drawn to the psychological aspects of the novel and the writers who focused on this theme (Dostoyevsky, kafka, Edith Wharton, to name a few.).

In my second year of teaching, a volunteered for a training program sponsored by the Psychology Department at Michigan State University:  The Listening Ear Crisis Intervention Center.  That was it for me!  The training program was 5 or 6 weeks long, and I loved every aspect of it.  I became a volunteer at “The Listening Ear,” found the work (and the opportunity for personal growth) exciting.  In addition, most of the volunteers were enrolled in one of the graduate psychology programs at MSU, so I had a good taste of what that graduate work would involve.  So, with an undergraduate degree in Literature, and a Masters degree in The Teaching of English,  I went off to become a psychologist.  No regrets!

What is your training/educational background?

My Ph.D. is from Michigan State University (Clinical/Counseling Program) and my internship was done at the University of Texas-Austin, in the Counseling Center.

What got you interested in pain psychology and what was your experience with health and pain psychology?

In the late ‘70’s and early ‘80’s (yikes!) a new field of Health Psychology was emerging, and I attended sessions on the topic at APA. I was at the Counseling Center at the U of Iowa at the time, and Bill Dougherty, PhD had just written a book on the role of the psychologist in Family Medicine.  I met with him, became very interested in this new application of professional psychology, and shortly thereafter took a job as the Behavioral Science Coordinator of the Family Practice Residency Program at Community Hospitals in Indianapolis.  It was a steep learning curve, but a very rewarding one.

After seven years in that position, I fulfilled my long term dream of moving to California.  The position I accepted was with Kaiser, in the ADAP (drug and alcohol recovery) Program.  Again, it was a sharp learning curve, but tremendously satisfying.

Those two experiences (Family Medicine and Alcohol/Drug Recovery) were a great background for becoming the Program Director of a Chronic Pain Management Program at Kaiser-San Francisco. I was fortunate to receive this position, as I had no formal training in pain management per se.  My training had been through conferences and workshops and readings and consultations with physicians.  Fortunately, by then (the early ‘90’s) there was a substantive body of literature developing, as well as excellent workshops and seminars available.  Along the way I also received training in Ericksonian Hypnosis as well as Transcendental Meditation, all of which proved very useful.  It was, again, a steep learning curve.

What were your most significant positions in pain psychology?

My only full time position in Pain Psychology was as Coordinator of the Interdisciplinary Chronic Pain Management Program at Kaiser-San Francisco (1995-2006).  From 2007-2017, I also had a solo private practice where I worked with clients with chronic pain conditions.

What has been your most rewarding experience working in pain psychology?

My most rewarding experience in the field of pain psychology has simply been the multitude of patients who have said, time after time, “thank you for helping me getting my life back.”   That is the common theme expressed by patients who have learned to effectively manage their chronic pain conditions.  Beyond that, working with and learning from a lot of great colleagues has been at the top of my reward list.

What are your biggest contributions to the field of pain psychology thus far?

I have two contributions I think of in retrospect as having had a very positive impact on the field.  The first is that at Kaiser-San Francisco, where we were able to do some program outcome research (unfortunately never published) showing clearly that patients who completed our multidisciplinary program had fewer doctor office visits for a period of two years following graduation from the program.  We were basically minimizing excessive “doctor shopping in search of a cure,” and we were minimizing the number of unnecessary and sometimes dangerous procedures that patients had previously demanded.  This was not only beneficial for the patients, but also secured our role in the medical center as a needed service, which in turn secured funding for the program, which allowed us to continue serving the patients (and the physicians of those patients) who needed us.

The second contribution was the development of a postdoctoral pain psychology training program, which meant that there were eventually many more well-trained psychologists throughout the Bay Area and beyond, available to serve the needs of patients with chronic pain conditions.

What advice would you give to people interested in, or just starting out, in pain psychology?

The field of pain psychology has grown exponentially since the days when I was learning on the job.  Anyone interested or just starting out would benefit greatly by taking advantage of the formal training experiences now available.  In addition, I think it is essential for psychologists to work with and learn from the other disciplines which can play a role in a patient’s pain management: physical therapists, movement therapists, acupuncturists, biofeedback practitioners, nutritionists, physiatrists, and anesthesiologists.  Each field has important contributions to make, and it’s very beneficial to the patient when the psychologist (often in the coaching role) has a good sense of what other modalities could be beneficial.

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