Susan Jarquin, PhD from the Division of Pain Management at UPMC

Chronic pain can be isolating and debilitating. Susan Jarquin, PhD from the Division of Pain Management at UPMC discusses how pain psychology can be a useful tool for patients in their treatment plans.

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– [Narrator] This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.

– Chronic pain can be isolating and debilitating. But, more and more, pain psychology is becoming an important part of treatment plans. Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat Podcast. And joining us right now is Dr. Susan Jarquin. She’s a licensed psychologist, assistant professor in the Department of Anesthesiology, and the pain rehabilitation coordinator in the division of Pain Management at UPMC. Thank you so much for joining us.

– Yes, thank you for having me.

– So, this is really a fascinating topic: pain psychology. This doesn’t mean the doctor thinks all the pain’s in your head, correct?

– Yes, that’s right. The doctor doesn’t think that. If the doctor is recommending pain psychology, it’s really just an indication that the doctor appreciates that chronic pain really necessitates various modes of treatment, including psychology services.

– OK. And so, then, what would you tell someone pain psychology is?

– Well, I’ll typically describe pain psychology as teaching people to use psychology skills to respond to pain or pain-related problems effectively.

– And this is really becoming more and more prevalent in medicine, a big area of research, including here at the University of Pittsburgh.

– Yeah, the involvement of psychology services in medical care, or in pain management specifically, it is more of a prevalent service. And, you’re right: There is pain psychology research happening here at the University of Pittsburgh. One of the more prominent pain psychologists who conduct research here is Charles Jonassaint in the Department of Internal Medicine. I’m more of a clinician than a researcher, but I also have done some research with the group in the Division of Pain Management. We’ve looked at the role that pain psychology services play in improving people’s impression of change when they’re receiving chronic pain care. So, yeah, there is a lot of research on this topic now, which is great.

– And, as you mentioned, so the research is underway. You are actually implementing this daily with patients. And, sort of, let’s talk a little bit about the UPMC Division of Pain Management, and, really, what goes on there, and then your role there.

– Sure. So, the Division of Pain Management is really composed of a host of different health care providers, including physicians, nurses, medical assistants, psychologists, social workers, psychiatrists. So, we have really a multidisciplinary team, which is excellent because that’s what chronic pain care really necessitates. We collaborate very closely with occupational therapists and physical therapists who are specifically trained in the treatment of chronic pain, which is great because it allows us, again, to provide our patients with more modes of chronic pain care. In terms of what pain psychology involves, it’s really about learning how people are responding to pain and determining whether people could benefit from learning to use psychology skills. So, by that, I mean something like a relaxation practice to respond to the pain or the pain-related problems that they deal with more effectively.

– Typically, we think of medicine, and we think of the body, and we’re fixing things that are wrong with the body, and we’re curing this, and we’re curing that. Why do you feel this is so important to have this component of pain psychology as part of treatment?

– Well, I think so much of pain management involves psychology. Because even if you think about someone taking a medication reliably, there’s a psychology to that. So, just the fact that so much of pain management involves people’s psychology, it’s important. I think psychology’s great, too, in pain management because people really have this opportunity to talk about what they’re experiencing. And chronic pain is a condition that is very poorly understood outside of pain management. People will describe all the time feeling very misunderstood by those in their lives, or those around them, or even by medical providers. And, so, I think it’s just so great to be able to afford patients this opportunity to have a conversation, and be able to open up, and receive that support and understanding that I think we all need when we’re going through something that’s challenging.

– What do you want to say about how this is one piece to the larger puzzle, and your whole team’s at the table?

– That’s the thing about being a psychologist and treating people living with pain. I would not want to do it in private practice because chronic pain really does necessitate this multidisciplinary, multimodal approach. And, so, to have ready access to a host of different specialists who are able to provide the patients you treat with these various modes of treatment is just so necessary and so relieving. So, it’s definitely like a team-based sport. It really is a problem, or health problem, that requires a team.

– Right. And are patients skeptical at first when they come to you?

– Yeah, I think patients can be skeptical. I think patients can also be unfamiliar with this idea of pain psychology. It’s not necessarily common knowledge that there’s a psychology specialty focused on the treatment of chronic pain. But I think patients, or in my experience, patients tend to be open to this idea of learning to use psychology skills to respond to what they’re dealing with more effectively. I always let patients know that it’s up to them. It’s a voluntary service. It’s their choice. And I always give patients the opportunity to think about or consider after providing them with an explanation of what the service involves if they want to think about whether they want to return. So, it’s very no pressure, totally up to you, whatever you think might be in your best interest.

– Do you feel like some patients come to you and say, “Well, I have nothing else to lose at this point because I’m dealing with so much pain, so I might as well talk with you?”

– Yeah, I think sometimes people will say that. The thing about pain psychology, and this isn’t really what you’re asking me, but this is something that’s important to think about, is the sooner you can involve pain psychology services in the treatment of chronic pain, the better. People should really almost think about it as a first-line treatment rather than a treatment of last resort because psychological problems or challenges will compromise people’s ability to benefit from medical interventions or rehab interventions. So, involving psychology services at the outset can allow people to get the most out of all the treatments they receive for pain.

– What is it like when someone comes to see you? Can you walk us through the process of what that might look like?

– The patients who we see are usually referred to us by one of the physicians or advanced practice providers from the Division of Pain Management. And, usually, the first meeting is, we’ll describe it as an intake, lasts typically about 60 minutes. And, mainly, I’m interested in learning about the pain history and again, how people are coping with pain, how they’re being affected by the pain that they live with. I’ll gather some history on involvement in mental health care, some background. And, like I’ve said, I’m really kind of interested in learning about how people are responding to what they’re dealing with pain-wise and if they could benefit and are interested in learning to use psychology skills to cope more effectively.

– And, so let’s talk about some of the specifics. I hear lots of terms. Cognitive behavioral therapy – what is that?

– So, cognitive behavior therapy is a type of psychotherapy, an evidence-based psychotherapy that is commonly used in the treatment of chronic pain. People will think about it as the gold standard psychological treatment for pain because it has the greatest evidence base to support its use in the treatment of this problem.

– And, so, how is it normally carried out? What happens with it?

– So, CBT really involves providing people with education on chronic pain and then providing patients with CBT skills that they can use to cope with pain or pain-related problems well.

– And, what would be an example of some of those skills?

– So, examples of CBT skills include relaxation practices or rethinking skills. There’s also this idea or this concept of time-based pacing. So, helping people figure out how much of an activity they can do before the pain gets worse, and then helping people figure out when they should stop and then go back to an activity. Another example of a CBT skill would be behavioral activation. So, getting people activated and helping people figure out how to do things that they may now be afraid to do because they’re concerned that the activity will worsen their experience of pain.

– And you talked about changing thoughts. So, if a negative thought pops into your head, is the theory teaching folks how to change that thought or turn that thought around?

– Yeah. So, that’s a great question. I’ll sometimes describe it as helping people recognize the types of unhelpful thoughts or thinking traps that they can fall into. And then helping people figure out ways to rethink or reframe that thought in a way that might serve them better.

– Acceptance and commitment therapy. What is that?

– Yeah, so acceptance and commitment therapy is a type of cognitive behavior therapy, and it’s an evidence-based psychotherapy. It is used often in the treatment of chronic pain, but it can also be used to treat other types of problems, such as depression or anxiety. Acceptance and commitment therapy is primarily concerned with helping people demonstrate greater psychological flexibility. So, that’s kind of like a jargon term, but psychological flexibility really gets at helping people figure out how to do things that are important to them or value consistent, even when internal experiences like emotions or thoughts make it difficult to do so. You could also describe acceptance and commitment therapy as being concerned with helping people bring awareness to the present moment, to be open to different types of experiences both internally and externally, and, again, to help people move towards, or engage, or commit, with what’s most important to them.

– Is it setting small goals? How does this acceptance therapy play out?

– By learning what’s most important to people, what they want their lives to be about. You could talk about that in terms of people’s values and then helping people figure out ways that they’re still able to demonstrate their values even with the health problems that they’re contending with. And even when their mind or their emotions may be promoting avoidance.

– I guess every patient would be different, but is there a typical length of time it might take for a patient to begin to see results from pain psychology?

– Well, sometimes people, even just in that initial intake appointment, will describe a feeling or experiencing a sense of relief just to have that opportunity to open up and talk about what they’ve been going through, and to have that be received in a caring and respectful way, and for someone to actually demonstrate understanding of what they’ve been living with. The people benefit, you’re right, in their own time course. And, it really depends a lot on people’s willingness and ability to practice what they’re learning in sessions, between sessions. Kind of like that expression, “You get out of it what you put into it.” It also depends on, I think, people’s expectations and level of motivation in terms of how much they’re going to get out of the service or how much benefit they’ll perceive that they derive from the service.

– Right. And, what is it like for patients, and what is it like for you when you begin to see someone succeed and feeling better?

– Well, for me, it’s gratifying. It’s satisfying. Chronic pain is a very challenging problem to treat. It doesn’t always respond to treatments. And, so, when you do have instances of patients responding well, it feels great because people living with pain, their lives can be very difficult. And to see them experience a sense of relief or improvement is really – it’s gratifying.

– I was sort of thinking of this in terms of adults, but children, pain psychology is important in the treatment of children as well.

– Yes. At Children’s Hospital there is a pediatric pain psychologist, Dr. Rosalind Butterfield. She works with the pain physician, Dr. Scott Brancolini, and she will also use these evidence-based psychotherapies, including CBT as well as others, to help pediatric patients living with pain.

– And, what would you want to say to somebody who is going through chronic pain but might be hesitant to see someone or to talk to someone about it?

– Demonstrate psychological flexibility. Well, I tease, but I think just an openness to experience, an openness to trying new things.

– Right. And do you envision this will continue to grow, and evolve, and become more commonplace?

– I hope that more psychologists pursue this type of career or pursue work in this type of field because there’s such a demand for it. And I just love the idea of psychologists being part of a big academic or health care center. I think I’m biased, but I think psychologists have so much to offer patients, and medical providers, or even just in leadership roles. I think psychology has so much value to add at all levels of a health care system.

– Well, Dr. Susan Jarquin, thank you so much for coming in and spending time with us today. Some great information. We thank you for your time.

– Happy to be here. Thank you for including me.

– You’re welcome. I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

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