Kimeron Hardin, PhD, ABPP

Kimeron Hardin, PhD, ABPP

7.17.2024

In 1990, early in my pain psychology career, working with people living with chronic pain was quite different than it is today. At that time, there was a burgeoning awareness that the traditional Western approach to chronic pain was not solving the problems and that somehow, the “psychosocial” part of the biopsychosocial model was important, but not yet an established part of treatment protocols. I had exactly zero training in pain or pain psychology in my first pain clinic experience as an intern at Duke University Medical Center, but I was young, had some background in health psychology in general, and had the enthusiasm to try to learn and absorb as much as I could from the professionals around me.

The pivotal work of George Engel (1981) on the biopsychosocial model of clinical treatment had a strong influence on my thinking at the time, expanding my consideration of the multiple layers of illness upward into the larger social, global, and universal realms and downward to the cellular level.

When my first book came out in 1996, The Chronic Pain Control Workbook (2nd edition), Ellen Catalano and I made a rough attempt to incorporate psychological concepts into the management of chronic pain. I was proud of my work bringing new psychosocial approaches and education to people living with pain in ways that could help them begin to assume more control over the quality of their lives without relying solely on physicians to solve the problem. Yet not long after it was published, a pain fellow at the academic center, where I worked, mentioned that he had seen the book in passing and laughed at the thought that such a book could provide anything useful to people living with severe, chronic pain. I have to admit that I was a bit crestfallen, but the contrast between the medical and the psychological worlds could not have been clearer to me at that moment.

Although Melzack and Wall’s GateControl concept was surely interesting to the pain specialists, making theoretical connections between the cognitive and emotional aspects of the brain to the experience of pain, it clearly planted a seed for change in the way that chronic pain is now approached. How that theory could be applied to clinical practice, however, has taken time and faced many barriers including a general resistance to systemic change in medical education and practice, socioeconomic and insurance disparities, and a lack of advanced training for psychology professionals with an interest in providing care to the pain populations.

Fortunately, once medical practitioners realized the benefits of referring their long-term, chronic pain patients for psychological care, the trend has exploded with most pain practices associating themselves, formally or informally, with a mental health professional willing to work with sometimes medically complex people.

I, for example, have worked exclusively in pain management for the entirety of my professional career across many settings, which allowed me to have incredible opportunities to understand the exciting and effective interventions out there, and what my typical clients were experiencing. Having been through the “surgery is the only option” many times and then through the opiates are the safe and best way to ease suffering phase, and more recently, the “neuromodulation implant” age, I have gained so much awareness from my clients about their successes and failures with these approaches.

Some of the most exciting advancements of late include the use of brain imaging for people living with chronic pain. We are learning about connections between various processing centers in the brain and pain in ways that we could only surmise through clinical experience and practice.

We now understand more about why treating chronic pain in the same ways that we were taught to manage acute pain is incorrect, and in some cases, harmful. While acute pain is viewed as rising up the spinal cord to the brain, chronic pain is now understood to descend from the brain, often with little input from the original site of injury.

It was a fallacy that acute pain treatments would work for chronic pain and in part, according to Haider Warraich, MD, author of “The Song of Our Scars: The Untold Story of Pain,” was responsible for the opioid epidemic and the prevention of other treatments that might have been helpful. He notes that brain imaging has revealed that the limbic system, or emotional brain, is much more involved in the experience of chronic pain than in acute pain. To the nervous system, he says, chronic pain is more like an emotion that we feel in a part of our body. His final point is that the ideal approach to pain management is interdisciplinary and that recognizing that pain is worsened by psychological factors does not make it “less real.”

While science is helping to validate the effectiveness and validity of our practices as pain psychology providers, many barriers remain to quality care for people living with chronic pain.

At this time, there are no guidelines for the practice of pain psychology, there are no global certifications, and very little graduate training in this field of specialization. Scientific discoveries and understanding sometimes take years to impact training and practice.

We must come together, as pain psychology professionals, to both develop the training and the standardization of practice if we want to see substantial change in the way that chronic pain is treated.

We need your talent, your curiosity and your creativity as we build the American Association of Pain Psychology.

If you care about this field helping to speed up the effective care of people living with chronic pain, please consider getting involved with the organization at whatever level you can spare. You are welcome to be a part of this developing association and help us make the future for our patients and our professional colleagues. We have a particular need right now for committee members for our DEI and Membership committees so please consider giving back to your profession and your specialty in pain psychology!  Please email your interest to us at info@aapainpsychology.org

Engel, G. L. (1981). The Clinical Application of the Biopsychosocial Model, J of Medicine and Philosophy, 6, 101-123.0360-5310/81/0062

Katz J, Rosenbloom BN. The golden anniversary of Melzack and’s gate control theory of pain: Celebrating 50 years of pain research and management. Pain Res Manag. 2015 Nov-Dec;20(6):285-6. doi:10.1155/2015/865487. PMID: 26642069; PMCID: PMC4676495.

Warraich, H. 2022. The Song of Our Scars:  The Untold Story of Pain. Basic Books: New York.

 

6.12.2024

May just ended, yet I thought I’d take a moment to celebrate Mental Health Awareness Month here in June. This is a reminder to take some time to check in with your body and mind and to make mental health awareness a regular part of your life not just one month a year.

Our organization was founded on a desire to provide excellent mental health care for people living with pain. We chose to do this by providing quality, advanced educational training in pain psychology for professionals to ensure that our clients receive the best treatment possible.

Today’s column, however, will be focused on self-care for our members. As many of you know, working as a healthcare provider can be exhausting. Beyond the physical demands of a busy practice, most of us use a lot of energy as we listen carefully, run through the diagnostic and therapy plan options, and establish and maintain rapport, sometimes with clients who were referred to us reluctantly and may not always be initially receptive to what we have to offer.

My question for you today is how are you taking care of yourself?

Most of us offer guidance regularly to our clients on self-care strategies and techniques. Yet, sometimes, we find ourselves out of balance. We are putting more energy into work, meetings, or home chores than we’d like. Often reaching a crescendo of long hours and intrusion into sleep patterns. We end up sacrificing our walks, exercise, nutritional habits, and other ways that we restore and refresh.

Self-care is the cornerstone of being an effective mental health professional. It allows us to sit and listen with less distraction. We model through action and demeanor for our community. Our goal is to gain personal insights that will be useful as we guide others toward effective choices.

In an excellent literature review by *Posluns and Gall published in the International Journal of Advanced Counseling in 2019, they found that a proactive stance toward self-care can help reduce negative outcomes experienced by practitioners and improve the care of clients. They noted that there is good empirical evidence supporting the consideration of self-care domains of awareness, balance, flexibility, physical health, social support, and spirituality. Among the specific strategies for cultivating these domains include:

Mindfulness and meditation training

Regular self-reflection

Expressive writing and journaling

Leisure activities

Variation in work activities

Non-work related passions and relationships

Time management and taking breaks

Flexible work hours and locations

Realistic work goals

Peer consultation

An open attitude and adaptability

Self-compassion

Professional development

Sleep hygiene and balanced diet/hydration

Exercise

Social support

Spiritual practice

Meaningful or purposeful work or hobbies

This is a reminder to take some time for you to check in with your body and mind and to make mental health awareness a regular part of your life, not just a one month a year.

4.26.2024

Part of my goal with the President’s Corner this year is to keep members informed about our current and upcoming events and projects. In this column, I have multiple exciting  events and projects to share, which I plan to do at the end. Another goal for me is to share more about our mission and larger goals, and that’s where I want to start this piece.

AAPP began in 2010 organized by a few isolated mental health professionals who were working with clients living with chronic pain in the San Francisco Bay Area, most with very little direct training in pain medicine and varying levels of experience in the field. At the time there were no requirements for training in pain, and the few courses that did offer instruction were part of a larger and more general health psychology track. There were a handful of internship and postdoctoral experiences in pain, each turning out — at best — a few dozen clinicians with significant pain management knowledge. Also at the time there were increasing numbers of jobs for mental health professionals, primarily and even exclusively in pain management clinics or programs.

These career paths were being created by advances in the understanding of the complexity of pain and the nervous system via models such as the Gate Control Theory and later, the Neuromatrix Theory. The growing awareness of limitations of traditional clinical medical practices to produce significant change for large numbers of people living with pain also were leading to increased collaboration between with mind and body professionals.

Early in my own career, my typical referral was for crisis management in people with long-standing and complex pain issues that had reached the end of their emotional rope. Most came with great skepticism and looming hopelessness that life could be better, especially after physicians “ran out” of interventional options. Eventually, after many serious conversations with my referring physicians and begging for a look at people earlier in the pain process, I started seeing clients before the hopelessness and desperation had set in, and who were more open to learning better skills for pain management. Any time I ran across another mental health professional working in pain management I felt almost immediate kinship, both with the struggle we shared to better understand pain management and to help our clients living with pain. Over time, we established loose connections and referral networks between us until our conversations began to turn towards forming a group that was more substantial and reliable.

Initially, our organization started in the San Francisco Bay Area and was named the Northern California Association of Pain Psychologists, later changed to the American Association of Pain Psychology, our current moniker, to reflect a growing interest from people outside the Bay area and California. While grateful for the important research on this topic that was constantly happening in academic circles, the clinical needs seemed to eclipse the growth of our highly specialized subspecialty with health psychology.

Our early goals for AAPP were simple: to provide a place for professionals to connect and share, and also to begin to provide cutting-edge education and training for interested professionals. For the past decade we have succeeded in providing high quality pain education, at first through live events, and now through streaming and webinars. Past speakers have included such luminaries as Sean Mackey, MD, Peter Levine, PhD, and Janina Fisher, PhD, to name a few.

This year, our stable of presenters began with an excellent talk on “A Primer on Biofeedback Devices for Pain Management” by Dr. Anu Kotay. Our next event by Abhishek Gowda, MD, on June 16th, will address the most recent changes to the 2022 CDC Opioid  Guidelines and the Use of Buprenorphine. Later in the year, we are excited to welcome Dr. Jeffrey Gold, on September 5th, on the use of virtual reality with pediatric pain; also, Dr. Lorimer Mosely, author of “Explain Pain,” for a live and streamed event from UCSF on  October 3rd. Dr. Moseley’s talk will be our first live and in-person event (“hybrid”) since the pandemic, so we are particularly excited about this.

Aside from our usual goal of providing quality education, we also are stepping up our effort to provide opportunities for our members to meet for consultation and peer discussions on complicated cases or issues. Our board member, Allison Bicksler, PhD, is taking the lead with this project, and we believe that this will help us fill a need we’ve been hearing from our members over the past couple of years for connection and mentoring.

Lastly, our other big news is that we have begun developing specialty committees for members interested in helping us expand our outreach and growth. Our first two committees will be our Membership Growth committee, headed by Dr. Consuelo Flores, to help us grow our membership numbers by reaching out to clinicians who might not have heard of us; and our Diversity committee, chaired by Dr. Heather Martarella, which is committed to expanding our membership into underrepresented professional communities and clients. If you might be interested in joining one of our first two committees, please let us know at info@painpsychology.org.

Thank you and hope to see you soon!

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Hello everyone!

Marilyn Jacobs and I have just returned from the 2024 American Academy of Pain Medicine conference in Scottsdale, AZ full of excitement and a sense of accomplishment from manning the AAPP booth over the weekend.

There were around 450 RSVP’d attendees plus an unknown number of “day of” registrations.  The overwhelming majority of attendees were physicians and other pain providers such as nurse practitioners and physicians-in-training with a sprinkling of psychologists and other mental health providers and students.

Our booth looked amazing with Darlene’s help getting the banner and the table skirt and brochures together.  The packet of abstracts and references were also quite the hit.

Although the actual number of psychologists stopping by our table was small, most of the medical providers indicated that they worked closely with at least one mental health provider and all of those indicated that they would be passing our information along to them and encouraging them to join.

Some of the current leadership of AAPM stopped by for extended chats about our organization including the immediate past president, Dr. Farshad Ahadian and Dr. Robert Wailes, the AAPM delegate to the AMA house of delegates.  Other notable people stopping by included Dr. Sean Mackey and Beth Darnall, PhD from Stanford.  It appears that membership numbers for psychologists are down for the organization and this year there were no pain interest group meetings leading Dr. Darnall to comment that AAPP is poised to fill a large gap for pain psychology practitioners.

I have to say that Marilyn was a real tiger when it came to drawing people in, and then engaging them in stimulating conversation about the importance of pain psychology.  Her breadth and depth of knowledge about pain medicine and integrated care was on full display and was quite impressive for our organization.

We don’t have hard numbers yet, but my guess if that we handed out over 100 flyers and 75% of our high quality pens (which were spontaneously acknowledged to us) so Chris was right about keeping an eye on our merch throughout the day.  Many of the people who stopped by had never heard of us before, so I believe that our larger mission of getting our organization’s name and mission out there was met.

About 40 people gave us their business card or name and contact info as a part of the raffle drawing for the three books.  Our winners were extremely excited to pick up their prizes and posed for pictures that we can include on the website.

During our time between visitors, we made a list of ideas about how to improve this process and continue to do outreach for members.

We ultimately believe that we should continue to exhibit at future conferences based on this experience.

Now that the banner, table skirt and flyers are created, it should be much easier to set up at future conferences.  I believe that Amanda mentioned a pediatric conference coming up.  Marilyn and I also think it would be great to have representation at APA’s convention in Seattle from August 8-10 in case someone is interested in representing us there.

Here are a few pictures of our experience and the winners from our book raffle.

Explain Pain | By Dr. David Butler & G. Lorimer Moseley Awarded by AAPP to: Sunannika Palec, M.D. Interventional Pain Medicine, Physical Medicine and Rehabilitation Post Doctoral Fellow Montefiore Medical Center, Einstein Campus Bronx, New York [Research Project in the U.S. from Phitsanulok, Thailand]

The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering | By Melanie Thernstrom Awarded by AAPP to: Chandramouli Iyer, M.D., FIPP, DABA Anesthesiology, Pain Management UT Southwestern Medical School Dallas, Texas LTC US Army Reserve Pain Clinic Dallas Veterans Affairs Medical Center Dallas, Texas

The Story of Pain: From Prayer to Painkillers | By Joanna Bourke Awarded by AAPP to: Eric Pearson, M.D. Anesthesiology, Pain Management, Interventional Pain Medicine Meridian Total Pain Care Meridian, Mississippi

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