March 2024 Howard Rome, PhD.

March 2024 Howard Rome, PhD.

What 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.

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