Your thoughts, beliefs, and expectations—your mindset—impact your health, how quickly you heal, and how well medications work for you—including powerful opioid painkillers. It’s important to develop new drugs and surgical techniques to address health problems like pain.
But what if we invested in changing patients’ mindsets so that these treatments worked better? And so that some people would not need them at all. My science focuses on mindset intervention for pain relief to address one of the most pressing healthcare problems in the world.
Thirty to 40 percent of people worldwide are living with ongoing pain. Chronic pain is more prevalent and costly than heart disease, diabetes, and cancer—combined. Chronic pain is the number one reason people are out of work and is one of the main reasons for lost productivity. Estimates suggest it costs the U.S economy $635 billion each year.
Chronic pain persists because the treatments are inadequate. No matter where pain is felt in the body, pain is processed in the central nervous system: the brain and the spinal cord. Pain is highly responsive to each person’s psychology and mindset, and this presents an opportunity.
A negative pain mindset — a pattern of expecting worse pain, feeling helpless about it, and ruminating on it — is what we call “pain catastrophizing” and it predicts your pain intensity, your need for opioid medication, length of hospital stay after surgery, how well your pain treatments work and whether you become disabled from pain.
Negative pain mindset undermines recovery and predicts the development of chronic pain. You were born motivated to escape pain but you were not born knowing how to modulate pain or the distress that it causes you. This must be learned.
I have developed brief, low-cost, and scalable interventions that teach people how to calm the nervous system and cultivate thought patterns that enhance functioning in regions of the brain associated with pain control. Patients entrain new neural networks that correlate with pain relief. And patients report having less pain. Patients learn how to train their brains away from pain, with lasting results.
Our recent research has shown that a targeted, two-hour pain relief mindset class equips patients with the tools to alter the trajectory of their pain. They gain control over their own experience of pain. Now, we are applying mindset science to help prevent pain after surgery.
Every year millions of patients develop chronic pain after surgery, in part due to mindset factors. A negative pain mindset has been shown to affect surgical outcomes more powerfully than the disease, the surgeon, or the surgery type. At Stanford, we are characterizing patients before surgery to determine who is at risk. Then we introduce them to a fully automated, online pain relief mindset intervention designed to help them optimize their postsurgical outcomes (“My Surgical Success”).
Science conducted by our research group and others has shown that a negative pain mindset entrains neural networks and brain connectivity in such a way that the nervous system is primed for future pain.
But effective psychological treatment for pain changes the physical structure—and the functioning of the brain—so you are primed for relief. When pain relief skills are actively used, pain processing is diminished in the nervous system.
Now we are applying mindset science to the largest health issue in the United States: risks associated with long-term opioid use. Many patients would like to reduce their opioid use but believe and fear that their pain will worsen if they do. Our interventions enhance patients’ positive expectations and therefore their willingness to partner with their doctors to taper their opioids.
The Patient-Centered Outcomes Research Institute just awarded me and my team almost $9 million to study our techniques in over a thousand patients taking long-term opioids. Rather than forcing patients down a care pathway that amplifies their fears, we are partnering with them on the path to less pain and fewer pills.
Health and pain relief mindset interventions can be applied as early as possible to help medical and pain treatments work better. This the power of mindset science — patient empowerment, and cost-effective, low-risk pain relief.
Learn more in my recent articles on pain psychology treatment that published in TIME Magazine (“3 Science-Backed Ways to Relieve Pain and Stress”) and in The Washington Post article (“Stanford Researchers: The Secret to Overcoming the Opioid Crisis May Lie Partly in the Mind”). I am excited to present this science at the 2018 World Economic Forum in Davos, Switzerland, where I will be speaking to world leaders on The Psychology of Pain Relief and patient empowerment.
1. Darnall BD, Sturgeon JA, Hah JM, Kao MC, Mackey SC. ‘From Catastrophizing to Recovery’: A pilot study of a single-session treatment for pain catastrophizing. J Pain Research. 2014; (7):219-226. PMID: 24851056.
2. Jiang Y, Oathes DJ, Hush J, Darnall BD, Charvat M, Mackey S, Etkin A. Perturbed Amygdalar Connectivity with the Central Executive and Default Mode Networks in Chronic Pain. PAIN ®.2016 Sep;157(9):1970-8. doi: 10.1097/j.pain.0000000000000606.
3. Seminowicz DA, Shpaner M, Keaser ML, Krauthamer MG, Mantegna J, Dumas JA, Newhouse PA, Filippi C, Keefe FJ, Naylor MR. Cognitive-Behavioral Therapy Increases Prefrontal Cortex Gray Matter in Patients With Chronic Pain. J Pain. 2013 Dec; 14(12):1573-84. Epub 2013 Oct 14.