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16 Articles in Volume 19, Issue #2
Analgesics of the Future: Inside the Potential of Glial Cell Modulators
APPs as Leaders in Pain Management
Cases in Urine Drug Monitoring Interpretation: How to Stay in Control (Part 1)
Complex Chronic Pain Disorders
Efficacy of Chiropractic Care for Back Pain: A Clinical Summary
Hydrodissection for the Treatment of Abdominal Pain Caused by Post-Operative Adhesions
Letters: The Word "Catastrophizing;" AIPM Ceases Operations; Patient Questions
Management of Severe Radiculopathy in a Pregnant Patient
Managing Pain in Adults with Intellectual Disabilities
Pain in the Courtroom: An Excerpt
Q&A with Howard L. Fields: How Patients’ Expectations May Control Pain
Special Report: CGRP Monoclonal Antibodies for Chronic Migraine
The Management of Chronic Overlapping Pain Conditions
Vibration for Chronic Pain
What are the dangers of loperamide abuse?
When Patient Education Fails to Improve Outcomes: A Low Back Pain Case

Letters: The Word "Catastrophizing;" AIPM Ceases Operations; Patient Questions

March 2019 PPM Letters to the Editor from practitioner peers and patients.
Pages 10-11

The Conflict Over the Term “Catastrophizing”

Stanford University Clinical Professor Beth Darnall’s interview with PPM reporter Kerri Wachter about pain catastrophizing, published in our January/February 2019 issue, garnered ample attention on Twitter. Individuals on both the patient and provider side took offense to the term, despite Dr. Darnall’s statement in the article that: “Even though we study pain catastrophizing, I prefer talking about ‘negative regulation of pain’ or ‘negative pain appraisal’ because it is more acceptable to patients.” She added, after the article’s publication, “We have to work really hard to dismantle resistance to the word. People generally agree with the need to address the phenomenon and the principles involved, but the word is stigmatizing.”

You can catch up on the constructive conversation on Twitter @PracticalPain or @BethDarnall. Here are a few snippets*:

The term ‘catastrophizing’ is unfortunate. Chronic pain patients live out real catastrophes, compounded by under-treatment and stigmatization of pain. Let’s find a different vocabulary to teach stress control and self-management. –Richard Lawhern

These terms need to go. They are unacceptable. There is nothing wrong with teaching patients mindfulness but there are just some pains that all the mindfulness in the world can’t help in any significant way. Would the term ‘sadness catastrophizing’ be acceptable for those with depression? –Wanita Umer

I choose to advocate for those whose opinion is that this language is harmful and is often used by medical professionals to dismiss distress, implying that what is a physiological difficulty is psychological. –Katy Phillips

Maybe, the problem isn’t the word or the idea? If we are told to do X to help our pain, we do X, it offers some subjective relief by calming or preventing us from losing our minds, but does not change the pain as a whole or the need for treatment. –Speaks4Majority

100% agree the term ‘catastrophizing’ is most often pejorative. I also agree (as stated in the article) that if you ‘help patients feel that they have more control. Not only does more control make pain more tolerable for patients, it also helps them have a better response to the medical treatment.’ –Billie Jo Bogden

Agree with all concepts. But ‘catastrophizing’ needs to be eliminated. People don’t realize how much abuse pain patients are put through trying to get help. This sounds like another way of saying ‘hysteria’ or ‘all in your head.’ Response will be defensiveness, not hearing the message. –JC

It’s helpful to take it in context. Many intractable pain patients have moments of gripping terror, fear, and despair. That’s expected, and what she’s trying to explain is that it’s just a word that describes a constellation of emotions we all feel, but can mitigate with intention. –Andrea Anderson

See this issue’s Spotlight, for more on how optimism and expectations impact pain response.

AIPM News Brings Community Together

In late January, the Board of Directors of the Academy for Integrated Pain Management (AIPM) announced it would be ceasing operations and soliciting members’ permission to dissolve as an organization, after 30 years of service to the pain community. PPM shared this news with its LinkedIn group (find us at: LinkedIn.com/Company/PracticalPainManagement).

With nearly 1,000 impressions, below are a few of the thoughts* shared online:

It’s a truly sad day when the national and international ‘war on opioids’ has to be sidetracked and possibly set back, secondary to lack of ongoing funding for or offers to subsidize the ongoing operations of AIPM. Perhaps, public or private sources to continue the outstanding work of the largest worldwide organization promoting the integrative pain management model can be found… Since its inception in 1988, AIPM has led the nation in efforts to educate health care providers, policymakers, and people with pain about this model of care. As a member of this organization, I am honored to have had the opportunity to interact and associate with the most caring, dedicated, and knowledgeable people. I have been an active member of professional organizations throughout my entire career, yet none have taken on the challenge and demonstrated the accomplishments of AIPM! –Alan Kaul, PharmD, MBA, FCCP, DAAPM, Northeastern Univ. Bouve College of Health Sciences

The pain community needs you at all levels. We deeply appreciate your commitment, dedication, and many contributions. We look forward to your continued pain work and hope your transitions into new opportunities will soon be forthcoming! –Susan Stephenson, Independent Philanthropy Professional

It is hard to overestimate how influential the work AIPM has been, particularly in opening medicine’s eyes to the value of non-pharma pain management options – and at this juncture in the opioid/addiction crises. It has been a pleasure to work with Bob Twillman and his team in recent years as integrative options have risen to first-line treatment options. –Taylor Walsh, WholeHealthED

Join the rest of the LinkedIn conversation online today.

Questions From Our Readers

I have had several CT scans, which show that I have osteochondrosis in the discs between L2, L3, L4, and L5. I have had prolotherapy injections in my ankle and knee, with much benefit, and wonder if such injections would also be of benefit (rather than steroid injections) in my discs. –Martin

I am a 57-year-old female with osteoarthritis in my left knee and the left metacarpal/CMC joint. I would like to get more information about different options in regenerative medicine for treatment of osteoarthritis. I understand there are various approaches, such as autologous stem cells, umbilical cells, PRP, growth hormones, and/ or combinations. I would like to know the difference in effectiveness and price for each option. –Azita

I am a nurse case manager and the physician following my patient has recommended genetic testing for appropriate pain medication management. What is the best way to get this test and analysis done? –Darlene, RN, CCM

*Minor edits made for clarity. 

Last updated on: June 6, 2019
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