CAP Profiles

Bio

Bio

Beth Darnall, PhD, is Clinical Associate Professor in the Department of Anesthesiology, Perioperative and Pain Medicine. She has about 15 years of experience treating individuals with chronic pain of varied etiologies and medical complexity. For example, she has worked extensively with individuals with spinal cord injury, catastrophic burn, amputation, chronic low back pain, migraine, fibromyalgia, and various types of musculoskeletal pain. At the Stanford Pain Management Center she primarily conducts pain psychology evaluation and has a very limited follow-up practice. She also delivers pro-bono group pain psychology services, including a novel single-session pain psychology class that she developed-- a targeted treatment for pain catastrophizing (a distressing pattern of thoughts and emotions commonly experienced by those with chronic pain). She is Co-Principal Investigator for an NIH R01 project that is studying the mechanisms of pain catastrophizing treatment, including the treatment class she developed. She has also developed a novel pre-surgical pain psychology treatment that can be delivered over the internet to patients before surgery as a pathway to reduce distress and optimize post-surgical healing and recovery (currently being tested in women undergoing surgery for breast cancer).

Her clinical practice, research and public education are designed to expand access to low-cost, high-quality treatment for pain. For example, she has developed and delivers free pain treatment classes to reduce treatment costs, uses internet and mobile device treatment delivery platforms to reduce travel burden for patients, authors free pain education blogs, and authors affordable treatment books.

She is Co-Chair of the Pain Psychology Task Force at the American Academy of Pain Medicine, and is a recipient of the Presidential Commendation from the American Academy of Pain Medicine (2015).

Her main passion is empowering people with chronic pain to harness the power of their mind-body connection to reduce symptoms, optimize health, and increase quality of life. She is author of "Less Pain, Fewer Pills: Avoid the Dangers of Prescription Opioids and Gain Control Over Chronic Pain" © 2014 and "The Opioid-Free Pain Relief Kit" © 2016. She blogs at "Psychology Today" and "The Huffington Post - Canada" on the topics of pain psychology and pain treatment.

www.bethdarnall.com
Twitter: @bethdarnall

Clinical Focus

  • Cognitive Behavioral Therapy for Pain
  • Pain Psychology
  • Psychology

Academic Appointments

  • Clinical Associate Professor, Anesthesiology, Perioperative and Pain Medicine

Honors & Awards

  • 2015 Presidential Commendation, American Academy of Pain Medicine (2015)
  • Elected Member, Association of University Anesthesiologists (2016)

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
  • 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 (2004)

Community and International Work

  • Stanford Free Back Pain Education Day 2015, Stanford University

    Topic

    Community Outreach for people with back pain

    Partnering Organization(s)

    Stanford Hospitals and Clinics

    Populations Served

    Chronic Back Pain

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Stanford 2014 Free Chronic Pain Education Day, Stanford University

    Topic

    Living Well with Chronic Pain

    Partnering Organization(s)

    Western Pain Society

    Populations Served

    Chronic Pain

    Location

    Bay Area

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

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

    Topic

    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

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    Yes

Contact

  • Stanford Univ Pain Management Ctr 450 Broadway St Pavilion A, FL 1, MC 5340 Redwood City, CA94063
    • Tel: (650) 723-6238
    Fax: (650) 721-3417

Links

Research & Scholarship

Current Research and Scholarly Interests

Current Grants:

NIH / NCCIH 09/01/2015 – 08/31/2020
R01AT008561
Title: Single Session Pain Catastrophizing Treatment: Comparative Efficacy & Mechanisms
This project will test the efficacy of a novel treatment for pain catastrophizing I developed and pilot tested at the Stanford Pain Management Center.
Multi-PI: Darnall & Mackey

NIH / NICHD 09/01/2015 – 08/31/2020
R01
Title: Maternal Chronic Pain: Risk for Pain and Poor Outcomes in Children
(PI: Anna Wilson, PhD)
Darnall, Site PI for Stanford University

Stanford Faculty Innovation Program 12/18/14 - 12/17/15
Title: Pain Clinic Optimization of Patient Experience (Pain COPE): Leveraging Open Source Learning Health System for Prescriptive Analytics Approach to Patient Satisfaction
$50,000
Multi-PI: Kao MC and Darnall


Current projects include:

(1) Pre-surgical delivery of single-session treatment for pain catastrophizing
(2) Mechanisms of pain catastrophizing treatment (pain-CBT and single-session tx)
(3) Quantitative sensory impacts of a pain catastrophizing induction in women with chronic pain
(4) Benzodiazepine and opioid prescribing patterns in US primary care visits
(5) Sex differences in brain structure for patients taking opioids for chronic pain vs. opioid naïve chronic pain patients
(6) Minimizing prescription opioid risks
(7) Mechanisms of complementary and alternative treatments for chronic low back pain
(8) Relationship between opioid prescribing and pain catastrophizing

I have dedicated a large portion of my professional career to studying pain catastrophizing, and quantifying the clinical and behavioral correlates, and to developing an effective, efficient, and specific treatment. I also developed a novel experimental model—a 10-minute pain catastrophizing induction—that allows us to study the immune responses (Darnall et al, Gender Med, 2010) and changes in sensory perception and neural functioning that occur after induced catastrophizing. These studies are designed to inform our understanding of the mechanisms by which pain catastrophizing shapes neural functioning, pain perception, and ultimately CNS structure in women with chronic pain. Current and future studies will use fMRI to examine the neurocorrelates, and CHOIR (Collaborative Health Outcomes Information Registry) to comprehensively phenotype the psychophysical impacts of pain catastrophizing, how we can reverse these negative psychobehavioral patterns (treatment mechanisms), and how early treatment may serve as chronic pain prophylaxis.

I have a specific passion for developing low-cost, low-burden, easily accessible treatments that reduce suffering in patients. My work in this area includes the development of 4 patient products: a book (Less Pain, Fewer Pills, 2014), an enhanced pain management CD (2013), an evidence-based DVD (2010) (Darnall & Li, J Rehabil Med, 2010), and a standard pain management CD (2010). In 2013, I developed a single-session 2-hour class to treat pain catastrophizing (Darnall et al, J Pain Res, 2014; also see ‘treatment’ at en.wikipedia.org/wiki/Pain_Catastrophizing). The class is novel because pain catastrophizing is typically treated across 6-12 individual or group psychology sessions, and thus treatment imposes substantial burdens to patients in terms of time and costs. We are now testing the single-session pain catastrophizing class in the perioperative setting to determine its efficacy in improving time to pain resolution and opioid cessation, as well as in improving other post-surgical outcomes.

Clinical Trials

  • Stanford Center for Back Pain Recruiting

    The purpose of the Stanford Center for Back Pain is to investigate and characterize the mechanisms of four treatments for chronic low back pain. These interventions (research treatment) include real-time fMRI neurofeedback, mindfulness based stress reduction, cognitive behavioral therapy, and acupuncture treatment. The investigators plan to characterize both mechanisms of treatment effects and efficacy.

    View full details

Teaching

2016-17 Courses

Publications

All Publications

  • Pain Psychology: A Global Needs Assessment and National Call to Action PAIN MEDICINE Darnall, B. D., Scheman, J., Davin, S., Burns, J. W., Murphy, J. L., Wilson, A. C., Kerns, R. D., Mackey, S. C. 2016; 17 (2): 250-263

    Abstract

    The Institute of Medicine and the draft National Pain Strategy recently called for better training for health care clinicians. This was the first high-level needs assessment for pain psychology services and resources in the United States.Prospective, observational, cross-sectional.Brief surveys were administered online to six stakeholder groups (psychologists/therapists, individuals with chronic pain, pain physicians, primary care physicians/physician assistants, nurse practitioners, and the directors of graduate and postgraduate psychology training programs).1,991 responses were received. Results revealed low confidence and low perceived competency to address physical pain among psychologists/therapists, and high levels of interest and need for pain education. We found broad support for pain psychology across stakeholder groups, and global support for a national initiative to increase pain training and competency in U.S. therapists. Among directors of graduate and postgraduate psychology training programs, we found unanimous interest for a no-cost pain psychology curriculum that could be integrated into existing programs. Primary barriers to pain psychology include lack of a system to identify qualified therapists, paucity of therapists with pain training, limited awareness of the psychological treatment modality, and poor insurance coverage.This report calls for transformation within psychology predoctoral and postdoctoral education and training and psychology continuing education to include and emphasize pain and pain management. A system for certification is needed to facilitate quality control and appropriate reimbursement. There is a need for systems to facilitate identification and access to practicing psychologists and therapists skilled in the treatment of pain.

    View details for DOI 10.1093/pm/pnv095

    View details for Web of Science ID 000373731000013

    View details for PubMedID 26803844

  • Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period. JAMA internal medicine Sun, E. C., Darnall, B., Baker, L. C., Mackey, S. 2016

    Abstract

    Chronic opioid use imposes a substantial burden in terms of morbidity and economic costs. Whether opioid-naive patients undergoing surgery are at increased risk for chronic opioid use is unknown, as are the potential risk factors for chronic opioid use following surgery.To characterize the risk of chronic opioid use among opioid-naive patients following 1 of 11 surgical procedures compared with nonsurgical patients.Retrospective analysis of administrative health claims to determine the association between chronic opioid use and surgery among privately insured patients between January 1, 2001, and December 31, 2013. The data concluded 11 surgical procedures (total knee arthroplasty [TKA], total hip arthroplasty, laparoscopic cholecystectomy, open cholecystectomy, laparoscopic appendectomy, open appendectomy, cesarean delivery, functional endoscopic sinus surgery [FESS], cataract surgery, transurethral prostate resection [TURP], and simple mastectomy). Multivariable logistic regression analysis was performed to control for possible confounders, including sex, age, preoperative history of depression, psychosis, drug or alcohol abuse, and preoperatice use of benzodiazepines, antipsychotics, and antidepressants.One of the 11 study surgical procedures.Chronic opioid use, defined as having filled 10 or more prescriptions or more than 120 days' supply of an opioid in the first year after surgery, excluding the first 90 postoperative days. For nonsurgical patients, chronic opioid use was defined as having filled 10 or more prescriptions or more than 120 days' supply following a randomly assigned "surgery date."The study included 641 941 opioid-naive surgical patients (169 666 men; mean [SD] age, 44.0 [12.8] years), and 18 011 137 opioid-naive nonsurgical patients (8 849 107 men; mean [SD] age, 42.4 [12.6] years). Among the surgical patients, the incidence of chronic opioid in the first preoperative year ranged from 0.119% for Cesarean delivery (95% CI, 0.104%-0.134%) to 1.41% for TKA (95% CI, 1.29%-1.53%) The baseline incidence of chronic opioid use among the nonsurgical patients was 0.136% (95% CI, 0.134%-0.137%). Except for cataract surgery, laparoscopic appendectomy, FESS, and TURP, all of the surgical procedures were associated with an increased risk of chronic opioid use, with odds ratios ranging from 1.28 (95% CI, 1.12-1.46) for cesarean delivery to 5.10 (95% CI, 4.67-5.58) for TKA. Male sex, age older than 50 years, and preoperative history of drug abuse, alcohol abuse, depression, benzodiazepine use, or antidepressant use were associated with chronic opioid use among surgical patients.In opioid-naive patients, many surgical procedures are associated with an increased risk of chronic opioid use in the postoperative period. A certain subset of patients (eg, men, elderly patients) may be particularly vulnerable.

    View details for DOI 10.1001/jamainternmed.2016.3298

    View details for PubMedID 27400458

  • From Catastrophizing to Recovery: a pilot study of a single-session treatment for pain catastrophizing JOURNAL OF PAIN RESEARCH Darnall, B. D., Sturgeon, J. A., Kao, M., Hah, J. M., Mackey, S. C. 2014; 7: 219-226

    Abstract

    Pain catastrophizing (PC) - a pattern of negative cognitive-emotional responses to real or anticipated pain - maintains chronic pain and undermines medical treatments. Standard PC treatment involves multiple sessions of cognitive behavioral therapy. To provide efficient treatment, we developed a single-session, 2-hour class that solely treats PC entitled "From Catastrophizing to Recovery" [FCR].To determine 1) feasibility of FCR; 2) participant ratings for acceptability, understandability, satisfaction, and likelihood to use the information learned; and 3) preliminary efficacy of FCR for reducing PC.Uncontrolled prospective pilot trial with a retrospective chart and database review component. Seventy-six patients receiving care at an outpatient pain clinic (the Stanford Pain Management Center) attended the class as free treatment and 70 attendees completed and returned an anonymous survey immediately post-class. The Pain Catastrophizing Scale (PCS) was administered at class check-in (baseline) and at 2, and 4 weeks post-treatment. Within subjects repeated measures analysis of variance (ANOVA) with Student's t-test contrasts were used to compare scores across time points.All attendees who completed a baseline PCS were included as study participants (N=57; F=82%; mean age =50.2 years); PCS was completed by 46 participants at week 2 and 35 participants at week 4. Participants had significantly reduced PC at both time points (P<0001) and large effect sizes were found (Cohen's d=0.85 and d=1.15).Preliminary data suggest that FCR is an acceptable and effective treatment for PC. Larger, controlled studies of longer duration are needed to determine durability of response, factors contributing to response, and the impact on pain, function and quality of life.

    View details for DOI 10.2147/JPR.S62329

    View details for Web of Science ID 000364587600005

    View details for PubMedID 24851056

  • 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

    Abstract

    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

    Abstract

    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

    Abstract

    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

    Abstract

    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

  • Pain Psychology and Pain Catastrophizing in the Perioperative Setting: A Review of Impacts, Interventions, and Unmet Needs. Hand clinics Darnall, B. D. 2016; 32 (1): 33-39

    Abstract

    This article provides a brief overview of the literature on perioperative pain psychology in terms of relevant factors and treatments. Where possible, the content emphasizes hand surgery or hand trauma populations, although this literature is notably limited, as well as the relevant musculoskeletal surgery literature. In addition, gaps in understanding and patient care are identified and discussed.

    View details for DOI 10.1016/j.hcl.2015.08.005

    View details for PubMedID 26611387

  • Conflict of Interest, Part II: Pain Society Leadership and Industry Pain Medicine Schatman, M. E., Darnall, B. D. 2016; 17

    View details for DOI 10.1093/pm/pnv041

  • Pain Psychology and the Biopsychosocial Model of Pain Treatment: Ethical Imperatives and Social Responsibility. Pain medicine (Malden, Mass.) Darnall, B. D., Carr, D. B., Schatman, M. E. 2016

    View details for DOI 10.1093/pm/pnw166

    View details for PubMedID 27425187

  • Pediatric-Collaborative Health Outcomes Information Registry (Peds-CHOIR): a learning health system to guide pediatric pain research and treatment. Pain Bhandari, R. P., Feinstein, A. B., Huestis, S. E., Krane, E. J., Dunn, A. L., Cohen, L. L., Kao, M. C., Darnall, B. D., Mackey, S. C. 2016

    Abstract

    The pediatric adaptation of the Collaborative Health Outcomes Information Registry (Peds-CHOIR) is a free, open-source, flexible learning health care system (LHS) that meets the call by the Institute of Medicine for the development of national registries to guide research and precision pain medicine. This report is a technical account of the first application of Peds-CHOIR with 3 aims: (1) to describe the design and implementation process of the LHS; (2) to highlight how the clinical system concurrently cultivates a research platform rich in breadth (eg, clinic characteristics) and depth (eg, unique patient- and caregiver-reporting patterns); and (3) to demonstrate the utility of capturing patient-caregiver dyad data in real time, with dynamic outcomes tracking that informs clinical decisions and delivery of treatments. Technical, financial, and systems-based considerations of Peds-CHOIR are discussed. Cross-sectional retrospective data from patients with chronic pain (N = 352; range, 8-17 years; mean, 13.9 years) and their caregivers are reported, including National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) domains (mobility, pain interference, fatigue, peer relations, anxiety, and depression) and the Pain Catastrophizing Scale. Consistent with the literature, analyses of initial visits revealed impairments across physical, psychological, and social domains. Patients and caregivers evidenced agreement in observable variables (mobility); however, caregivers consistently endorsed greater impairment regarding internal experiences (pain interference, fatigue, peer relations, anxiety, and depression) than patients' self-report. A platform like Peds-CHOIR highlights predictors of chronic pain outcomes on a group level and facilitates individually tailored treatment(s). Challenges of implementation and future directions are discussed.

    View details for DOI 10.1097/j.pain.0000000000000609

    View details for PubMedID 27280328

  • Social Disruption Mediates the Relationship Between Perceived Injustice and Anger in Chronic Pain: a Collaborative Health Outcomes Information Registry Study Annals of Behavioral Medicine Sturgeon, J. A., Carriere, J. S., Kao, M. J., Rico, T. J., Darnall, B. D., Mackey, S. C. 2016

    View details for DOI 10.1007/s12160-016-9808-6

  • Perturbed connectivity of the amygdala and its subregions with the central executive and default mode networks in chronic pain. Pain Jiang, Y., Oathes, D., Hush, J., Darnall, B., Charvat, M., Mackey, S., Etkin, A. 2016

    Abstract

    Maladaptive responses to pain-related distress, such as pain catastrophizing, amplify the impairments associated with chronic pain. Many of these aspects of chronic pain are similar to affective distress in clinical anxiety disorders. In light of the role of the amygdala in pain and affective distress, disruption of amygdalar functional connectivity in anxiety states, and its implication in the response to noxious stimuli, we investigated amygdala functional connectivity in 17 patients with chronic low back pain and 17 healthy comparison subjects, with respect to normal targets of amygdala subregions (basolateral vs centromedial nuclei), and connectivity to large-scale cognitive-emotional networks, including the default mode network, central executive network, and salience network. We found that patients with chronic pain had exaggerated and abnormal amygdala connectivity with central executive network, which was most exaggerated in patients with the greatest pain catastrophizing. We also found that the normally basolateral-predominant amygdala connectivity to the default mode network was blunted in patients with chronic pain. Our results therefore highlight the importance of the amygdala and its network-level interaction with large-scale cognitive/affective cortical networks in chronic pain, and help link the neurobiological mechanisms of cognitive theories for pain with other clinical states of affective distress.

    View details for DOI 10.1097/j.pain.0000000000000606

    View details for PubMedID 27168362

  • Contributions of physical function and satisfaction with social roles to emotional distress in chronic pain: a Collaborative Health Outcomes Information Registry (CHOIR) study PAIN Sturgeon, J. A., Dixon, E. A., Darnall, B. D., Mackey, S. C. 2015; 156 (12): 2627-2633

    Abstract

    Individuals with chronic pain show a greater vulnerability to depression or anger than those without chronic pain, and also show greater interpersonal difficulties and physical disability. The current study examined data from 675 individuals with chronic pain during their initial visits to a tertiary care pain clinic using assessments from Stanford University's Collaborative Health Outcomes Information Registry (CHOIR). Using a path modeling analysis, the mediating roles of PROMIS Physical Function and PROMIS Satisfaction with Social Roles and Activities were tested between pain intensity and PROMIS Depression and Anger. Pain intensity significantly predicted both depression and anger, and both physical function and satisfaction with social roles mediated these relationships when modeled in separate 1-mediator models. Notably, however, when modeled together, ratings of satisfaction with social roles mediated the relationship between physical function and both anger and depression. Our results suggest that the process by which chronic pain disrupts emotional well-being involves both physical function and disrupted social functioning. However, the more salient factor in determining pain-related emotional distress appears to be disruption of social relationships, rather than global physical impairment. These results highlight the particular importance of social factors to pain-related distress, and highlight social functioning as an important target for clinical intervention in chronic pain.

    View details for DOI 10.1097/j.pain.0000000000000313

    View details for Web of Science ID 000365598300028

  • Toward the Healthiest Symbiosis. Pain medicine Darnall, B. D., Schatman, M. E. 2015; 16 (7): 1254-1255

    View details for DOI 10.1111/pme.12828_3

    View details for PubMedID 26133016

  • The Relationship Between Industry and Pain Societies, Part 1: Demystification and Legitimization of Continuing Medical Education PAIN MEDICINE Darnall, B. D., Schatman, M. E. 2015; 16 (7): 1251-1251

    View details for DOI 10.1111/pme.12828

    View details for Web of Science ID 000358017000004

    View details for PubMedID 26138746

  • Protecting the infant from unknown risks. Pain medicine Darnall, B. D., Schatman, M. E. 2015; 16 (4): 631-632

    View details for DOI 10.1111/pme.12718_4

    View details for PubMedID 25832321

  • Opioid use and lactation: protecting the child in the context of maternal pain care. Pain medicine Darnall, B. D., Schatman, M. E. 2015; 16 (4): 628-?

    View details for DOI 10.1111/pme.12718

    View details for PubMedID 25766069

  • Physical and psychological correlates of fatigue and physical function: a Collaborative Health Outcomes Information Registry (CHOIR) study. journal of pain Sturgeon, J. A., Darnall, B. D., Kao, M. J., Mackey, S. C. 2015; 16 (3): 291-8 e1

    Abstract

    Fatigue is a multidimensional construct that has significant implications for physical function in chronic non-cancer pain populations but remains relatively understudied. The current study characterized the independent contributions of self-reported ratings of pain intensity, sleep disturbance, depression, and fatigue to ratings of physical function and pain-related interference in a diverse sample of treatment-seeking individuals with chronic pain. Methods: These relationships were examined as a path modeling analysis of self-report scores obtained from 2,487 individuals with chronic pain from a tertiary care outpatient pain clinic.Our analyses revealed unique relationships of pain intensity, sleep disturbance, and depression with self-reported fatigue. Further, fatigue scores accounted for significant proportions of the relationships of both pain intensity and depression with physical function and pain-related interference, and accounted for the entirety of the unique statistical relationship between sleep disturbance and both physical function and pain-related interference.Fatigue is a complex construct with relationships to both physical and psychological factors that has significant implications for physical functioning in chronic non-cancer pain. The current results identify potential targets for future treatment of fatigue in chronic pain, and may provide directions for future clinical and theoretical research in the area of chronic non-cancer pain.Fatigue is an important physical and psychological variable that factors prominently in the deleterious consequences of pain intensity, sleep disturbance, and depression for physical function in chronic non-cancer pain.

    View details for DOI 10.1016/j.jpain.2014.12.004

    View details for PubMedID 25536536

  • Physical and Psychological Correlates of Fatigue and Physical Function: A Collaborative Health Outcomes Information Registry (CHOIR) Study JOURNAL OF PAIN Sturgeon, J. A., Darnall, B. D., Kao, M. J., Mackey, S. C. 2015; 16 (3): 291-298

    View details for DOI 10.1016/j.jpain.2014.12.004

    View details for Web of Science ID 000351027300010

  • Compassion Cultivation in Chronic Pain May Reduce Anger, Pain, and Increase Acceptance: Review and Commentary Health Care: Current Reviews Darnall, B. D. 2015; 3 (1)
  • Urine drug screening: opioid risks preclude complete patient autonomy. Pain medicine Darnall, B. D., Schatman, M. E. 2014; 15 (12): 2001-2002

    View details for DOI 10.1111/pme.12604_4

    View details for PubMedID 25376661

  • Urine drug screening: necessary or alienating? Pain medicine Darnall, B. D., Schatman, M. E. 2014; 15 (12): 1999-?

    View details for DOI 10.1111/pme.12604

    View details for PubMedID 25376375

  • Intrathecal Opioids for Chronic Nonmalignant Pain: A Case Study and the Search for Balance PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2014; 15 (8): 1268-1268

    View details for DOI 10.1111/pme.12494

    View details for Web of Science ID 000342630800005

    View details for PubMedID 25091712

  • Minimize opioids by optimizing pain psychology. Pain management Darnall, B. D. 2014; 4 (4): 251-253

    View details for DOI 10.2217/pmt.14.18

    View details for PubMedID 25300380

  • Compassion meditation training for people living with chronic pain and their significant others: a pilot study and mixed-methods analysis JOURNAL OF PAIN Ruchelli, G., Chapin, H., Darnall, B., Seppala, E., Doty, J., Mackey, S. 2014; 15 (4): S117-S117

    View details for Web of Science ID 000334648700465

  • Proinflammatory cytokines and DHEA-S in women with fibromyalgia: impact of psychological distress and menopausal status JOURNAL OF PAIN RESEARCH Sturgeon, J. A., Darnall, B. D., Zwickey, H. L., Wood, L. J., Hanes, D. A., Zava, D. T., Mackey, S. C. 2014; 7: 707-716

    Abstract

    Though fibromyalgia is not traditionally considered an inflammatory disorder, evidence for elevated inflammatory processes has been noted in this disorder in multiple studies. Support for inflammatory markers in fibromyalgia has been somewhat equivocal to date, potentially due to inattention to salient patient characteristics that may affect inflammation, such as psychiatric distress and aging milestones like menopause. The current study examined the relationships between proinflammatory cytokines and hormone levels, pain intensity, and psychological distress in a sample of 34 premenopausal and postmenopausal women with fibromyalgia. Our results indicated significant relationships between interleukin-8 and ratings of pain catastrophizing (r=0.555, P<0.05), pain anxiety (r=0.559, P<0.05), and depression (r=0.551, P<0.05) for postmenopausal women but not premenopausal women (r,0.20 in all cases). Consistent with previous studies, ratios of interleukin-6 to interleukin-10 were significantly lower in individuals with greater levels of depressive symptoms (r=-0.239, P<0.05). Contrary to previous research, however, dehydroepiandrosterone sulfate did not correlate with pain intensity or psychological or biological variables. The results of the current study highlight the importance of psychological functioning and milestones of aging in the examination of inflammatory processes in fibromyalgia.

    View details for DOI 10.2147/JPR.S71344

    View details for Web of Science ID 000364591400001

    View details for PubMedID 25506243

  • Upscheduling of Hydrocodone: Convenience and Access vs Patient Safety Measures PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2013; 14 (11): 1627-1627

    View details for DOI 10.1111/pme.12257

    View details for Web of Science ID 000327011600004

    View details for PubMedID 24238351

  • Medical marijuana: a viable tool in the armamentaria of physicians treating chronic pain? A case study and commentary. Pain medicine Schatman, M. E., Darnall, B. D. 2013; 14 (6): 799-?

    View details for DOI 10.1111/pme.12137

    View details for PubMedID 23647910

  • A Pendulum Swings Awry: Seeking the Middle Ground on Opioid Prescribing for Chronic Non-Cancer Pain PAIN MEDICINE Schatman, M. E., Darnall, B. D. 2013; 14 (5)

    View details for Web of Science ID 000319279800032

    View details for PubMedID 23581746

  • 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

    Abstract

    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

  • HOME-BASED SELF-DELIVERED MIRROR THERAPY FOR PHANTOM PAIN: A PILOT STUDY JOURNAL OF REHABILITATION MEDICINE Darnall, B. D., Li, H. 2012; 44 (3): 254-260

    Abstract

    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

    Abstract

    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

    Abstract

    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

    Abstract

    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