Beth Darnall | |
---|---|
Born | Las Cruces, NM |
Citizenship | United States |
Alma mater | Texas Woman's University University of Colorado, Boulder Johns Hopkins School of Medicine |
Known for | Pain psychology and voluntary opioid reduction |
Scientific career | |
Fields | Behavioral Medicine for Pain |
Institutions | Stanford University |
Website | https://profiles.stanford.edu/beth-darnall |
Beth Darnall is American scientist, pain psychologist, author, and Associate Professor of Anesthesiology, Perioperative and Pain Medicine at the Stanford University School of Medicine where she directs the Stanford Pain Relief Innovations Lab. [1] From 2005 to 2012, Darnall was an assistant professor and associate professor at Oregon Health & Science University.
She is known for developing and investigating brief and scalable behavioral medicine treatments for acute, post-surgical [2] [3] [4] and chronic pain [5] [6] [7] [8] [9] [10] [11] , leading teams of investigators in the conduct of federally-funded randomized controlled clinical pain treatment trials, research on patient-centered voluntary prescription opioid tapering [12] [13] [14] [15] [16] [17] [18] , advocacy for patient protections during opioid tapering [19] [14] [12] [20] [21] , and vocal opposition of forced opioid tapering practices [22] [23] . She is creator of Empowered Relief(R), a 1-session (2 hour) pain relief skill intervention that has been shown to be non-inferior to 8-session cognitive behavioral therapy for reducing multiple symptoms at 3 months post-treatment (pain distress, pain intensity, pain interference, sleep disturbance, fatigue, depression and anxiety). [24] The study publication was covered by the National Institutes of Health [25] and multiple media outlets including The New York Times, [26] MedPage Today [27] and Physician's Weekly. [28]
A study of online delivered Empowered Relief(R) in patients with different types of chronic pain showed multidimensional benefits across a range of outcomes at 3 months post-treatment (compared to a usual care control group). [6] In 2019, the Health and Human Services Pain Task Force [29] cited Empowered Relief as being an important and promising solution to address the unmet need of broad scale access to behavioral pain care in the U.S. Empowered Relief(R) is being delivered by more than 1,000 certified instructors in 25 countries and in 7 languages. [30] Tailored versions of Empowered Relief(R) have been created for people with injury/surgery, opioid use disorder, Veterans, and youth with pain.
In 2018 she briefed the U.S. Congress on the opioid and pain crises, and in 2019 provided invited testimony to the FDA on iatrogenic harms from forced opioid tapering. Her work has been featured in Scientific American, NPR Radio, BBC Radio, and Nature. [31] In 2018 she spoke on the psychology of pain relief at the World Economic Forum in Davos, Switzerland. [32] Since 2019 she has served as Chief Science Advisor at AppliedVR, [33] a virtual reality therapeutics company that published the first study reporting on at-home skills-based virtual reality for chronic pain treatment. [34] Follow-on studies have included a randomized placebo-controlled trial of an 8-week home-based virtual reality program for chronic pain with clinical efficacy demonstrated to 24-months post-treatment. [9] [35] [36] [37]
In 2020 Darnall was appointed a scientific member of the National Institutes of Health (NIH) Interagency Pain Research Coordinating Committee (IPRCC) by U.S. Health and Human Services Secretary Dr. Alex Azar. [38] In 2020, she was appointed to the Centers for Disease Control and Prevention (CDC) opioid workgroup, [39] a group that is charged with reviewing the scientific evidence for acute and chronic pain opioid prescribing guidelines and making recommendations on the planned 2021 CDC opioid prescribing guideline. In 2021 Darnall was elected to the Board of Directors of the American Academy of Pain Medicine.
Darnall graduated from Texas Woman's University with a B.A. in mass communications in 1994. She received her M.A. and Ph.D. in clinical psychology from the University of Colorado, Boulder in 1998 and 2002, respectively. She completed a post-doctoral fellowship in rehabilitation medicine at Johns Hopkins School of Medicine in 2004.
Darnall is principal investigator for large NIH and PCORI-funded national and multi-site clinical trials that broadly investigate behavioral medicine strategies for acute and chronic pain, and voluntary patient-centered prescription opioid reduction. [14] [40] [41]
Darnall is the author of over 100 journal articles. [42]
She has authored three books:
She coauthored a fourth book with Heath McAnally and Lynn Freeman: Preoperative Optimization of the Chronic Pain Patient. [46]
Darnall was the 2012 president of the Pain Society of Oregon.
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."
Chronic pain is classified as pain that lasts longer than three months. In medicine, the distinction between acute and chronic pain is sometimes determined by the amount of time since onset. Two commonly used markers are pain that continues at three months and six months since onset, but some theorists and researchers have placed the transition from acute to chronic pain at twelve months. Others apply the term acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no fixed duration, is "pain that extends beyond the expected period of healing".
Fibromyalgia is a medical condition defined by the presence of chronic widespread pain, fatigue, waking unrefreshed, cognitive symptoms, lower abdominal pain or cramps, and depression. Other symptoms include insomnia and a general hypersensitivity.
Pain management is an aspect of medicine and health care involving relief of pain in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.
Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use disorder, reversing opioid overdose, and suppressing cough. Extremely potent opioids such as carfentanil are approved only for veterinary use. Opioids are also frequently used non-medically for their euphoric effects or to prevent withdrawal. Opioids can cause death and have been used for executions in the United States.
Low back pain (LBP) or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute, sub-chronic, or chronic. The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain. The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people recovered by six weeks.
Transcutaneous electrical nerve stimulation is the use of electric current produced by a device to stimulate the nerves for therapeutic purposes. TENS, by definition, covers the complete range of transcutaneously applied currents used for nerve excitation although the term is often used with a more restrictive intent, namely to describe the kind of pulses produced by portable stimulators used to reduce pain. The unit is usually connected to the skin using two or more electrodes which are typically conductive gel pads. A typical battery-operated TENS unit is able to modulate pulse width, frequency, and intensity. Generally, TENS is applied at high frequency (>50 Hz) with an intensity below motor contraction or low frequency (<10 Hz) with an intensity that produces motor contraction. More recently, many TENS units use a mixed frequency mode which alleviates tolerance to repeated use. Intensity of stimulation should be strong but comfortable with greater intensities, regardless of frequency, producing the greatest analgesia. While the use of TENS has proved effective in clinical studies, there is controversy over which conditions the device should be used to treat.
Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.
Oxymorphone is a highly potent opioid analgesic indicated for treatment of severe pain. Pain relief after injection begins after about 5–10 minutes, after oral administration it begins after about 30 minutes, and lasts about 3–4 hours for immediate-release tablets and 12 hours for extended-release tablets. The elimination half-life of oxymorphone is much faster intravenously, and as such, the drug is most commonly used orally. Like oxycodone, which metabolizes to oxymorphone, oxymorphone has a high potential to be abused.
Neuropathic pain is pain caused by damage or disease affecting the somatosensory system. Neuropathic pain may be associated with abnormal sensations called dysesthesia or pain from normally non-painful stimuli (allodynia). It may have continuous and/or episodic (paroxysmal) components. The latter resemble stabbings or electric shocks. Common qualities include burning or coldness, "pins and needles" sensations, numbness and itching.
Low-dose naltrexone (LDN) describes the off-label, experimental use of the medication naltrexone at low doses for diseases such as Crohn's disease, Hashimoto's and multiple sclerosis, but evidence for recommending such use is lacking.
Opioid-induced hyperalgesia (OIH) or opioid-induced abnormal pain sensitivity, also called paradoxical hyperalgesia, is an uncommon condition of generalized pain caused by the long-term use of high dosages of opioids such as morphine, oxycodone, and methadone. OIH is not necessarily confined to the original affected site. This means that if the person was originally taking opioids due to lower back pain, when OIH appears, the person may experience pain in the entire body, instead of just in the lower back. Over time, individuals taking opioids can also develop an increasing sensitivity to noxious stimuli, even evolving a painful response to previously non-noxious stimuli (allodynia). This means that if the person originally felt pain from twisting or from sitting too long, the person might now additionally experience pain from a light touch or from raindrops falling on the skin.
An equianalgesic chart is a conversion chart that lists equivalent doses of analgesics. Equianalgesic charts are used for calculation of an equivalent dose between different analgesics. Tables of this general type are also available for NSAIDs, benzodiazepines, depressants, stimulants, anticholinergics and others.
An opiate, in classical pharmacology, is a substance derived from opium. In more modern usage, the term opioid is used to designate all substances, both natural and synthetic, that bind to opioid receptors in the brain. Opiates are alkaloid compounds naturally found in the opium poppy plant Papaver somniferum. The psychoactive compounds found in the opium plant include morphine, codeine, and thebaine. Opiates have long been used for a variety of medical conditions with evidence of opiate trade and use for pain relief as early as the eighth century AD. Opiates are considered drugs with moderate to high abuse potential and are listed on various "Substance-Control Schedules" under the Uniform Controlled Substances Act of the United States of America.
Undertreatment of pain is the absence of pain management therapy for a person in pain when treatment is indicated.
Opioid rotation or opioid switching is the process of changing one opioid to another to improve pain control or reduce unwanted side effects. This technique was introduced in the 1990s to help manage severe chronic pain and improve the opioid response in cancer patients. In order to obtain adequate levels of pain relief, patients requiring chronic opioid therapy may require an increase in the original prescribed dose for a number of reasons, including increased pain or a worsening disease state. Over the course of long-term treatment, an increase in dosage cannot be continued indefinitely as unwanted side effects of treatment often become intolerable once a certain dose is reached, even though the pain may still not be properly managed. One strategy used to address this is to switch the patient between different opioid drugs over time, usually every few months. Opioid rotation requires strict monitoring in patients with ongoing levels of high opioid doses for extended periods of time, since long term opioid use can lead to a patient developing tolerance to the analgesic effects of the drug. Patients may also not respond to the first opioid prescribed to them at all, therefore needing to try another opioid to help manage their pain. A patient's specific response and sensitivity to opioids include many factors that include physiology, genetics and pharmacodynamic parameters, which together determine the amount of pain control and tolerance of a particular opioid.
Pain management in children is the assessment and treatment of pain in infants and children.
Opioid tapering is the reduction of opioid doses over time. Opioid tapering is typically done in people taking opioids for chronic pain. Tapering may be conducted in medically-supervised inpatient or outpatient settings.
Howard Lincoln Fields is an American neuroscientist and clinical neurologist with expertise in pain and in opioid pharmacology. He is currently professor of neurology and physiology emeritus at the University of California, San Francisco (UCSF).
In medicine, tapering is the practice of gradually reducing the dosage of a medication to reduce or discontinue it. Generally, tapering is done is to avoid or minimize withdrawal symptoms that arise from neurobiological adaptation to the drug.
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