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Medical Providers

To Medical Providers, Pain Organizations or Insurance Companies: 


Please visit the following resources for more information on pain management and Empowered Relief™.

We are available virtually to offer Empowered Relief™ to your employees and patients, and are willing to discuss arrangements to facilitate our services. 

Please contact us at

                            Drs. F. Cal Robinson and Brittany Robinson

Comparison of a Single-Session Pain Management Skills Intervention with a Single-Session Health Education Intervention and 8 Sessions of Cognitive Behavioral Therapy in Adults with Chronic Low Back Pain a Randomized Clinical Trial, Darnall, et al, JAMA Network Open (2021)

NIH-funded study suggests a single skills-based session on pain management packs a punch

New approach effectively relieves chronic low back pain - Stanford Scope, Published by Stanford Medicine

Effects of Psychologic Stress on Immune System

Steptoe, A., Hamer, M., & Chida, Y. (2007). The effects of acute psychological stress on circulating inflammatory factors in humans: A review and meta-analysis. Brain, Behavior, and Immunity, 21, 901–912.

Impacts of Cognition and Emotion on Pain

Bushnell, M. C., Cˇeko, M., & Low, L. A. (2013). Cognitive and emotional control of pain and its disruption in chronic pain. Nature Reviews Neuroscience, 14, 502–511.

Hubbard, C. S., Khan, S. A., Keaser, M. L., Mathur, V. A., Goyal, M., Seminowicz, D. A. Altered Brain Structure and Function Correlate with Disease Severity and Pain Catastrophizing in Migraine Patients. eNeuro. 10.1523/ENEURO.0006-14.2014

  • The authors found “..negative associations between pain catastrophizing and migraine disease variables and gray matter in areas implicated in processing the sensory, affective, and cognitive aspects of pain in patients.”

Jiang, Y., Oathes, D., Hush, J., Darnall, B., Charvat, M., Mackey, S., & Etkin, A. (2016). Perturbed connectivity of the amygdala and its subregions with the central executive and default mode networks in chronic pain. Pain, 157,1970–1978.


  • This study shows structural and functional changes in the brain with catastrophizing as mediating effects

Linton, S. J. (2005). Do psychological factors increase the risk for back pain in the general population in both a cross-sectional and prospective analysis? European Journal of Pain, 9, 355–361.


  • This study shows that pain catastrophizing predicts the development of chronic pain among healthy individuals.

Seminowicz, D. A., & Davis, K. D. (2006). Cortical responses to pain in healthy individuals depends on pain catastrophizing. Pain, 120, 297–306.

  • Pain catastrophizing is one of the highest yield therapeutic targets. This study shows how it impacts neural functioning and pain.

Vlaeyen, J. W., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85, 317–332.


  • Illustrates the role of catastrophizing in the pain, fear-avoidance, and disability cycle.

Wertli, M.M., Burgstaller, J.M., Weiser, S. et al. (2013). The Influence of Catastrophizing on Treatment Outcome in Patients with Non-Specific Low Back Pain: A Systematic Review. Spine. 1;39(3):263-73.10.1097/BRS.0000000000000110

  • Review and meta-analysis of 11 studies and 2269 patients. Catastrophizing predicted degree of pain and disability and mediated treatment efficacy in most studies.

Impacts of Catastrophizing on Surgical Outcomes

Riddle, D. L., Wade, J. B., Jiranek, W. A., & Kong, X. (2010). Preoperative pain catastrophizing predicts pain outcome after knee arthroplasty. Clinical Orthopaedics and Related Research, 468, 798–806.

Theunissen, M., Peters, M. L., Bruce, J., Gramke, H. F., & Marcus, M. A. (2012). Preoperative anxiety and catastrophizing: A systematic review and meta-analysis of the association with chronic postsurgical pain. The Clinical Journal of Pain, 28, 819–841.


Sullivan, M. J. L. (2009). The Pain Catastrophizing Scale Manual

  • The manual contains scientific background, the measure, and scoring guide

Treatment Effects and Research

Burns J. W., Kubilus A., Bruehl S., Harden R. N., Lofland, K. Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A crosslagged panel analysis. J Consult Clin Psychol. 2003; 71(1):81-91.

  • Early reductions in pain catastrophizing improve response to multidisciplinary pain care. Underscores need to provide access to effective pain catastrophizing first.

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.

  • This is the foundational article for “Empowered Relief”. Pilot outcomes show the single-session class effectively reduces pain catastrophizing.

Darnall BD, Ziadni MS, Roy A, Kao MC, Sturgeon JA, Cook KF, Lorig K, Burns JW, Mackey SC. Comparative Efficacy and Mechanisms of a Single-Session Pain Psychology: Protocol for a Randomized Controlled Trial in Chronic Low Back Pain. Trials 2018; 19:165. PMID: 29510735


  • This is the research protocol for the NIH-funded 3-arm RCT comparing

“Empowered Relief” to 8-session CBT and a health education intervention.

Darnall BD, Ziadni MS, Krishnamurthy P, Mackey IG, Heathcote L, Taub CJ, Flood P, Wheeler A. “My Surgical Success”: Impact of a digital behavioral pain medicine intervention on time to opioid cessation after breast cancer surgery. Pain Med. 2019 May 13. pii: pnz094. doi: 10.1093/pm/pnz094. PMID: 31087093.

  • “Empowered Relief” was tailored and digitized to create “My Surgical Success”. Pilot study showed patients who engaged with MSS stopped opioids 5 days sooner after surgery compared to a digital health education control group. NOTE: floor effect for PCS in this study.

Seminowicz, D. A., Shpaner, M., Keaser, M. L., Krauthamer, G. M., Mantegna, J., Dumas, J. A., Naylor, M. R. (2013). Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain. The Journal of Pain, 14, 1573–1584.

  • Functional and structural brain changes are reversed with 11-week CBT and effects are mediated by reductions in catastrophizing.

Binaural Beats

Padmanabhan R, Hildreth AJ, and Laws D. A prospective, randomized, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anaesthesia for day case surgery. Anaesthesia. 2005; 60:874-877.

  • Patients who received binaural beats during surgery evidenced lower anesthetic requirement. (Binaural beats are a component of the “Empowered Relief” treatment)

Oster G. Auditory Beats in the Brain. Scientific American. October 1973.

  • Scientific background on binaural beats and their ability to facilitate learning.

Schmid et al. Brainwave entrainment to minimize sedative drug doses in pediatric surgery: a randomized controlled trial. British Journal of Anaesthesia, 125 (3): 330e335 (2020).

  • Binaural beats effectively reduced the propofol infusion rates required for sedation in children undergoing surgery with regional anesthesia.

Additional Readings

Darnall BD & Colloca L. Optimizing Placebo and Minimizing Nocebo to Reduce Pain, Catastrophizing, and Opioid Use: A Review of the Science and an Evidence-Informed Clinical Toolkit. Int Rev Neurobiol. 2018;139:129-157. PMID: 30146045

  • Application of principles to reduce pain and support opioid tapering.

Darnall BD, Scheman J, Davins S, Burns JW, Murphy JL, Wilson AC, Kerns R, MackeySC. Pain Psychology: A global needs assessment and national call to action. Pain Medicine. 2016; 17(2): 250-263. Open Access available

  • This article describes the shortage of pain psychologists, barriers to care, and establishes a rationale for scalable solutions and broader professional training in pain education.


Darnall BD, Sturgeon JA, Cook KF, Taub CJ, Burns JW, Sullivan MJ, Mackey SC. Development and Validation of a Daily Pain Catastrophizing Scale. J Pain. 2017 Sep;18(9):1139-1149. doi: 10.1016/j.jpain.2017.05.003. PMID: 28528981.

  • The Daily PCS is a research tool to characterize daily pain catastrophizing. This article also confirms other work that suggests that catastrophizing is a unidimensional construct.

Darnall B. To treat pain, study people in all their complexity. Nature 2018 May; 557 (7703):7. PMID: 29717254.

  • Describes the imperative to treat the full definition of pain.

Feinstein AB, Sturgeon JA, Dunn A, Rico T, Darnall BD, Kao MC, Bhandari RP. The Effect of Pain Catastrophizing on Outcomes: A Developmental Perspective across Children, Adolescents and Young Adults with Chronic Pain. J Pain. 2016 Nov 4. pii:S1526-5900(16)30279-6. doi: 10.1016/j.jpain.2016.10.009.


  • This article provides a nice developmental perspective.

Patient Book

Darnall, B. (2016). The Opioid-Free Pain Relief Kit: 10 simple steps to ease your pain. Boulder, CO: Bull Publishing Company.

  • This patient book mirrors the practical content of “Empowered Relief” and includes the binaural MP3 audiofile.

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