Non-Pharmacological Management of Pain: Interview with Dr. Sara Edmond

Samantha G. Farris, PhD and Emily Walsh, BA; Pain SIG

Sara Edmond, PhD	Samantha G. Farris, PhD	Emily Walsh, BA

The Pain Special Interest Group (Pain SIG) recently interviewed Dr. Sara Edmond, a research and clinical psychologist at the Pain Research, Informatics, Multimorbidities and Education (PRIME) Center at VA Connecticut Healthcare System and an Associate Research Scientist in the Department of Psychiatry at Yale School of Medicine about her perspectives on encouraging the uptake of evidence-based non-pharmacological pain management strategies by enhancing patient-provider communication. Dr. Edmond’s editorial on pain was recently published in JAMA Psychiatry.  We were able to catch up with her about this publication and also to capture her expert insights on non-pharmacological management of pain in clinical practice.

Thank you Dr. Edmond for speaking with us on behalf of the Pain SIG. We’re excited to hear about your expertise in the non-pharmacological management of pain. Can you tell us about your current intervention study?

Pain SMART (Shared Medical Appointment to Refocus Treatment) is a single-session shared medical appointment intervention – shared meaning multiple providers working with a group of patients. The goal of Pain SMART is to enhance patient-provider communication about pain by using motivational interviewing strategies to discuss non-pharmacological treatments. Primary care providers often say that talking with their patients about chronic pain is challenging, and shared medical appointments are a more relaxed environment to facilitate this conversation. Patients also feel like they get more time with their providers. Another benefit is that Veterans enjoy hearing from one another. For example, in one group, one Veteran shared his experience with yoga for chronic pain and other Veterans seemed to appreciate hearing from a Veteran rather than a medical provider about what has worked.

What are some of the challenges in working with patients with lower motivation for utilizing non-pharmacological pain management approaches?

We’ve studied barriers to engaging in these treatments, and we’ve found that even though they are evidence-based, patients don’t know that, and sometimes, providers also don’t know. So, providers may not do a good job of selling these approaches to patients. Patients are, understandably, less motivated to try things if they are skeptical about their efficacy. Another factor is that some of these approaches require patients take a more active role in their care. Some patients have lower self-efficacy to implement those strategies. For instance, patients with kinesiophobia, or may be nervous to try exercise or physical therapy because they are fearful that it will make their pain worse.

It sounds like you collaborate with many different types of providers. What is it like collaborating with professionals who work outside of the field of behavioral medicine.

I work quite a bit in primary care, so I work with physicians who are not necessarily experts in behavioral medicine. I think medical schools are doing a much better job of emphasizing the biopsychosocial model, but there is still a tendency to treat pain from a biomedical standpoint. Primary care providers are often very burdened and feel a time crunch during patient appointments, so I’ve tried to give them brief scripts or short phrases that they can use to convey messages to their patients efficiently.

In your recent editorial published in JAMA Psychiatry, you outline three specific recommendations for what mental health clinicians can do to address pain in clinical practice. Tell us about those recommendations.

Another thing I’m passionate about is encouraging mental health clinicians to think about pain as part of their scope of practice, instead of as a medical problem.  The editorial suggests three ways to incorporate pain into routine clinical care. First, assess pain and the impact pain has on a patient’s life. Second, incorporate that knowledge into your case conceptualization and treatment planning. For example, if you ask your patient with PTSD to do exposure-based activities, consider whether those activities may also exacerbate pain, which could reduce treatment compliance. Third, reinforce the biopsychosocial model. Mental health providers can help patients understand how pain may relate to other problems.

What advice would you have for trainees who are interested in doing research in chronic pain?

Remember that pain is one of the most common presenting problems in patients in primary care and is one of the largest causes of disability. If you’re in a research setting or work with a population in which pain is not a specific focus, , consider how you could measure the prevalence or correlates of pain.

 

Check out these relevant publications:

Edmond, S.N, Heapy, A.A, & Kerns, RD, JAMA Psychiatry. 2019;76(6):565-566. doi:10.1001/jamapsychiatry.2019.0254

Ankawi, B., Kerns, RD, & Edmond, SN. Enhancing motivation for change in the management of chronic painful conditions: a review of recent literature. Curr Pain Headache Rep. 2019;23(10):75. doi: 10.1007/s11916-019-0813-x