Clinical Focus

  • Psychology
  • Pain Psychology

Academic Appointments

Professional Education

  • Fellowship:The Johns Hopkins University (2004) MD
  • Internship:Southern Arizona VA Healthcare System (2002) AZ
  • Medical Education:University of Colorado at Boulder (2002) CO
  • BA, Texas Woman's University, Journalism (1994)
  • MA, University of Colorado at Boulder, Clinical Psychology (1998)
  • PhD, University of Colorado at Boulder, Clinical Psychology (2002)
  • Post-Doc, The Johns Hopkins University School of Medicine, Rehabilitation Psychology

Community and International Work

  • Mirror therapy certification workshops for physicians, trauma, and healthcare providers in Vietnam, Can Tho, Dong Ha, and Hanoi, Vietnam


    Self-delivered mirror therapy for phantom pain

    Partnering Organization(s)

    International Association for the Study of Pain; End the Pain Project; HealthSaaS

    Populations Served

    Vietnamese amputees



    Ongoing Project


    Opportunities for Student Involvement


Research & Scholarship

Current Research and Scholarly Interests

A current study is entitled, "Pain catastrophizing and systemic inflammation in pre- and post-menopausal women with chronic pain." This is a randomized controlled, prospective experimental study with longitudinal follow-up for women with general musculoskeletal pain and women with fibromyalgia. All experiments are completed and data are being analyzed. All participants had a study visit that was standardized by menstrual phase (for pre-menopausal women). Baseline blood was collected via peripheral catheter. Participants assigned to the treatment arm of the study underwent a 10 min mental catastrophizing induction while the control group rested. Additional blood samples were collected at 1.5, 2.5, 3.5 and 4.5 hours post-catastrophizing stress (the blood collections for the control group were synchronized with this format). Serum is being assayed for a broad panel of pro-and anti-inflammatory cytokines. Our pilot work suggested that IL-6 and TNF-a are expressed in women with chronic pain following an imaginal catastrophizing experiment. We aim to better characterize these physiological responses, and to elucidate the balance between pro- and anti-inflammatory cytokines. We are following participants over time to determine whether cytokine responsivity is linked to pain progression.
Other research examines sex/gender differences in pain, pain psychology, and other pain treatment. Recent work has involved examining factors that predict opioid prescription, and consequences of long-term opioid use. As an outgrowth of my research and clinical work, I have wrote a book for people with chronic pain describing the connections between stress, pain, and opioids, and empowering patients to need less opioid painkiller medication and by optimizing cognitive and behavioral skills (to be published in 2013).


Journal Articles

  • Medical and Psychological Risks and Consequences of Long-Term Opioid Therapy in Women PAIN MEDICINE Darnall, B. D., Stacey, B. R., Chou, R. 2012; 13 (9): 1181-1211


    Long-term opioid use has increased substantially over the past decade for U.S. women. Women are more likely than men to have a chronic pain condition, to be treated with opioids, and may receive higher doses. Prescribing trends persist despite limited evidence to support the long-term benefit of this pain treatment approach.To review the medical and psychological risks and consequences of long-term opioid therapy in women.Scientific literature containing relevant keywords and content were reviewed.Long-term opioid use exposes women to unique risks, including endocrinopathy, reduced fertility, neonatal risks, as well as greater risk for polypharmacy, cardiac risks, poisoning and unintentional overdose, among other risks. Risks for women appear to vary by age and psychosocial factors may be bidirectionally related to opioid use. Gaps in understanding and priorities for future research are highlighted.

    View details for DOI 10.1111/j.1526-4637.2012.01467.x

    View details for Web of Science ID 000308713600011

    View details for PubMedID 22905834

  • Sex Differences in Long-term Opioid Use Cautionary Notes for Prescribing in Women ARCHIVES OF INTERNAL MEDICINE Darnall, B. D., Stacey, B. R. 2012; 172 (5): 431-432

    View details for Web of Science ID 000301381300012

    View details for PubMedID 22412108

  • Hysterectomy and Predictors for Opioid Prescription in a Chronic Pain Clinic Sample PAIN MEDICINE Darnall, B., Li, H. 2011; 12 (2): 196-203


    To describe the prevalence of hysterectomy for women aged 18-45 seeking treatment at a chronic pain clinic, to describe patient characteristics (pain intensity, age, smoking status, hormone replacement status, and psychosocial factors) based on opioid and hysterectomy status, and to determine whether hysterectomy status predicted receipt of opioid prescription.Retrospective cross-sectional chart review.Total 323 new female patients aged 18-45 who completed the Brief Pain Inventory-Short Form at initial evaluation at a chronic pain clinic during a 12-month period (July 2008-June 2009).Data were collected from the Brief Pain Inventory and medical charts. Variables included opioid prescription, average pain intensity, pain type, age, hysterectomy status, smoking status, and pain-related dysfunction across domains measured by the Brief Pain Inventory. The association of opioid prescription with hysterectomy and other factors were determined by logistic regression.Prevalence of hysterectomy was 28.8%. Average pain intensity was not associated with either hysterectomy or opioid prescription status. However, hysterectomy and high levels of pain-related dysfunction were significantly and independently associated with opioid prescription after adjusting for age and pain intensity. More than 85% of women with hysterectomy and high pain-related dysfunction had opioid prescription.Hysterectomy may confer risk for pain-related dysfunction and opioid prescription in women 45 and younger. More research is needed to understand 1) how patient characteristics influence prescribing patterns and 2) the specific medical risks and consequences of chronic opioid therapy in this population.

    View details for DOI 10.1111/j.1526-4637.2010.01038.x

    View details for Web of Science ID 000287200000003

    View details for PubMedID 21223499

  • Pilot Study of Inflammatory Responses Following a Negative Imaginal Focus in Persons With Chronic Pain: Analysis by Sex/Gender GENDER MEDICINE Darnall, B. D., Aickin, M., Zwickey, H. 2010; 7 (3): 247-260


    Recent evidence suggests that differential stress and immune responses may play a role in the sex/gender disparity for pain. Pain pathology and psychological stress are both associated with elevated levels of proinflammatory cytokines.This pilot study tested a negative imaginal focus to assess whether it would elicit a proinflammatory cytokine response and whether responses would vary by sex/gender.Adults with chronic musculoskeletal pain were recruited from an outpatient, multidisciplinary pain clinic in Portland, Oregon, between 2007 and 2008. All participants underwent a psychologist-guided 10-minute focus on the negative aspects of their pain condition and the imagined worsening of their pain; no control group was used. Serum collected at baseline and postfocus (1, 2, and 2.5 hours) was assayed for interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha). Cortisol was assayed at each time point and at 15 minutes postfocus.Thirty-six outpatients (aged 26-62 years; 23 women, 13 men) participated in the study. Compared with men, women displayed greater negative emotional expression during the experiment, and this in turn mediated their IL-6 inflammatory responses. Relative to men, the IL-6 response trajectory was delayed for women. The IL-6 and TNF-a findings suggest women's maximal cytokine responses were not captured by the final time point.This pilot study provides preliminary evidence that women with chronic pain may experience increased and delayed inflammatory responses following negative emotional expression induced by thinking negatively about their pain condition. The findings have implications for pain catastrophizing research. This early-phase research suggests that the timing and duration of the cytokine response are critical factors to consider in future pain research.

    View details for DOI 10.1016/j.genm.2010.06.003

    View details for Web of Science ID 000279749600007

    View details for PubMedID 20638630

  • Sex and gender in psychoneuroimmunology research: Past, present and future BRAIN BEHAVIOR AND IMMUNITY Darnall, B. D., Suarez, E. C. 2009; 23 (5): 595-604


    To date, research suggests that sex and gender impact pathways central to the foci of psychoneuroimmunology (PNI). This review provides a historical perspective on the evolution of sex and gender in psychoneuroimmunology research. Gender and sexually dimorphic pathways may have synergistic effects on health differences in men and women. We provide an overview of the literature of sex and gender differences in brain structure and function, sex steroids, gender role identification, hypothalamic-pituitary-adrenal axis function, genetics, immunology and cytokine response. Specific examples shed light on the importance of attending to sex and gender methodology in PNI research and recommendations are provided.

    View details for DOI 10.1016/j.bbi.2009.02.019

    View details for Web of Science ID 000267274000005

    View details for PubMedID 19272440

  • Autonomy vs paternalism in the emergency department: the potential deleterious impact of patient satisfaction surveys. Pain medicine Darnall, B. D., Schatman, M. E. 2013; 14 (7): 968-?


    Patient satisfaction surveys, such as Press Ganey, are flawed metrics for the emergency department setting and also in broader pain medicine. National experts discuss the pitfalls of applying such measures in pain care, and the potential unintended negative consequences to patients and providers alike. Evaluators, administrators, and payers are challenged to understand the limitations of Press Ganey and patient satisfactions in pain treatment, and the field is challenged to develop meaningful and valid metrics for best practices and competencies.

    View details for DOI 10.1111/pme.12170

    View details for PubMedID 23758676

  • A call to action and evolution. Pain medicine Darnall, B. D., Schatman, M. E. 2013; 14 (7): 969-970

    View details for DOI 10.1111/pme.12170_4

    View details for PubMedID 23855790

  • The Resurrection of the Ethics Forum in Pain Medicine: An Introduction PAIN MEDICINE Schatman, M. E., Darnall, B. 2013; 14 (4): 453-454
  • A practical and ethical solution to the opioid scheduling conundrum. Journal of pain research Schatman, M. E., Darnall, B. D. 2013; 7: 1-3

    View details for DOI 10.2147/JPR.S58148

    View details for PubMedID 24353439

  • Pain Characteristics and Pain Catastrophizing in Incarcerated Women with Chronic Pain JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Darnall, B. D., Sazie, E. 2012; 23 (2): 543-556


    Chronic pain in incarcerated women is understudied and poorly described. Study objectives were to describe pain characteristics, correlates, and predictors in a convenience sample of incarcerated women with chronic pain. A survey packet that included the Brief Pain Inventory Short Form (BPI-SF) and the Pain Catastrophizing Scale (PCS) was distributed to all inmates at a state prison for women. Those who self-identified as having chronic pain ?4 on a 0-10 numeric rating scale were invited to complete the survey. Demographics and medical and psychiatric diagnoses were abstracted by chart review. Participants (N=159) rated their current and average pain intensity as severe. Pain catastrophizing was found to predict average pain intensity and level of pain-related interference in functioning. Pain catastrophizing is treatable with behavioral intervention in the general population. Findings suggest that pain catastrophizing may be an important target for research and treatment in incarcerated women with chronic pain.

    View details for Web of Science ID 000303427600007

    View details for PubMedID 22643606



    To test the feasibility and preliminary efficacy of self-delivered home-based mirror therapy for phantom pain.Uncontrolled prospective treatment outcome pilot study.Forty community-dwelling adults with unilateral amputation and phantom pain >?3 on a 0-10 numeric rating scale enrolled either during a one-time study visit (n?=?30) or remotely (n?=?10).Participants received an explanation of mirror therapy and were asked to self-treat for 25 min daily. Participants completed and posted back sets of outcomes questionnaires at months 1 and 2 post-treatment. Main outcome was average phantom pain intensity at post-treatment.A significant reduction in average phantom pain intensity was found at month 1 (n?=?31, p?=?0.0002) and at month 2 (n?=?26, p?=?0.002). The overall median percentage reduction at month 2 was 15.4%. Subjects with high education (>?16 years) compared with low education (

    View details for DOI 10.2340/16501977-0933

    View details for Web of Science ID 000305492600011

    View details for PubMedID 22378591

  • Self-Delivered Home-Based Mirror Therapy for Lower Limb Phantom Pain AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION Darnall, B. D. 2009; 88 (1): 78-81


    Home-based patient-delivered mirror therapy is a promising approach in the treatment of phantom limb pain. Previous studies and case reports of mirror therapy have used a therapist-guided, structured protocol of exercises. No case report has described treatment for either upper or lower limb phantom pain by using home-based patient-delivered mirror therapy. The success of this case demonstrates that home-based patient-delivered mirror therapy may be an efficacious, low-cost treatment option that would eliminate many traditional barriers to care.

    View details for DOI 10.1097/PHM.0b013e318191105b

    View details for Web of Science ID 000262027100011

    View details for PubMedID 19096290

  • Depressive symptoms and mental health service utilization among persons with limb loss: results of a national survey. Archives of physical medicine and rehabilitation Darnall, B. D., Ephraim, P., Wegener, S. T., Dillingham, T., Pezzin, L., Rossbach, P., MacKenzie, E. J. 2005; 86 (4): 650-658


    To describe the prevalence of depressive symptoms, risk factors, and mental health service utilization in a national limb-loss sample.Cross-sectional survey.Participants were interviewed by telephone.A stratified sample by etiology of 914 persons with limb loss, derived from people who contacted the Amputee Coalition of America from 1998 to 2000.Not applicable.Center for Epidemiologic Study Depression Scale (CES-D 10-item), pain bothersomeness, characteristics of the amputation, sociodemographics, and mental health service utilization.Prevalence for significant depressive symptoms (CES-D score, >/=10) was 28.7%. Risk factors included being divorced or separated, living at the near-poverty level, having comorbid conditions, being somewhat bothered or extremely bothered by back pain and phantom limb pain, and having residual limb pain for persons aged 18 to 54. Having higher education was a buffer against depressive symptoms. Almost 22% of the sample and 44.6% of persons with significant depressive symptoms received mental health service in the previous year. For persons with significant depressive symptoms, 32.9% reported needing mental health service but not receiving them, and 67.1% reported not needing mental health service.Depressive symptoms are prevalent among persons with limb loss. Proper management of pain and medical comorbidity may mitigate depressive symptoms. Education about depressive symptoms and treatment options may improve receipt of mental health service among persons with limb loss reporting significant levels of depressive symptoms.

    View details for PubMedID 15827913

  • Modification of the cognitive model for bulimia via path analysis on a Brazilian adolescent sample ADDICTIVE BEHAVIORS Darnall, B. D., Smith, J. E., Craighead, L. W., Lamounier, J. A. 1999; 24 (1): 47-57


    Eating disturbances in middle-class Brazilian adolescents attending three high schools (one Military, two Private schools) were investigated. Participants from both Private schools were similar to U.S. samples on the EAT-26. Path analysis on the Private schools revealed the following. Higher body weight leads to weight concerns most strongly through greater discrepancy from the ideal, but it also leads directly to weight concern. Thus, both the reality of being heavier and the perception that one is larger than ideal (which could be due to being heavier and/or having a thin ideal) contribute to weight concern. Greater weight concern is associated most directly with lower self-esteem, which in turn is associated with endorsing greater importance of weight and shape. Importance of weight and shape contributes most powerfully to eating pathology through dieting, but this variable has a modest direct effect as well. These paths were not significant for the Military school sample in which participants reported lower levels of weight concern, dieting, body dissatisfaction, and a larger ideal figure. However, the Military sample rated importance of weight and shape as high as did Private-school participants. The results provide support for variables identified as important in the cognitive model of bulimia and suggest the model may be enhanced by including body weight and one's perceived ideal body shape as additional variables.

    View details for Web of Science ID 000077732100004

    View details for PubMedID 10189972

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