Opioids are not the solution for chronic pain, experts say, and only worsen the opioid epidemic. CBT may be one part of the solution
Urgent Calls for implementing evidence-based behavioral strategies in managing chronic pain have been issued by various agencies, including the National Institutes of Health (NIH) and the Institute of Medicine in the United States.
The principal interventions for relieving the psychological symptoms of chronic pain are cognitive behavioral therapy (CBT) and mindfulness treatments.
CBT includes several different strategies, with acceptance and commitment therapy (ACT) as one of the newest iterations. Each focuses on maladaptive or dysfunctional thinking and responses to stress, with ACT emphasizing acknowledgment and acceptance of these without requiring their resolution before progressing.
Key targets of CBT are reducing “catastrophizing,” which is when the patient is feeling helpless and overwhelmed, and identifying “secondary gains” from the impairment of pain, which may undermine motivation to resume work or interact with family or peers.
CBT can also increase both self-efficacy and the capacity to accept social support, as both are associated with greater tolerance of pain and reduction in perceived pain intensity.
Mindfulness treatments, including mindfulness-based stress reduction, mindfulness-based cognitive therapy, and mindfulness meditation, foster an awareness of the sensation of pain without judgment or emotional response.
In one assessment of the putative mechanisms underlying pain control from mindfulness meditation, published in Annals of the New York Academy of Sciences, the authors conclude that “analgesic effects of meditation can be developed and enhanced through greater practice, a critical consideration for those seeking long-lasting narcotic-free pain relief.”
Dawn C. Buse, Ph.D., an associate professor in the Department of Neurology at Albert Einstein College of Medicine of Yeshiva University in New York City, NY, explained to Medical News Today the value of behavioral strategies in treating patients with chronic pain.
“Behavioral treatment strategies for chronic pain have strong, proven efficacy, are cost-effective, and do not have side effects or interactions,” said Prof. Buse.
“They can be used through all stages of life where pharmacologic interventions may not be available or may be contraindicated, such as in childhood, pregnancy, or lactation. They can also help improve adherence to pharmacologic interventions, and can be used independently or combined with pharmacologic treatment interventions.”
Dawn C. Buse, Ph.D.
When referring a patient for treatment, Prof. Buse cautioned that the physician should not just “hand off,” but they should instead maintain a pivotal role in providing integrated care.
She also discussed the importance of choosing the type of intervention that is likely to be acceptable and effective for a particular patient.
Heather Tick, M.D., a professor for integrative pain medicine at the University of Washington in Seattle, explained to MNT that “pain education for most medical graduates is abysmal, yet pain is the main driver behind the majority of healthcare visits.”
“The conversation around pain is mainly around drugs,” Dr. Tick added. “It was all opioids before, now we know the dangers so it is about drugs to limit opioids. But all the non-pharmacological approaches rarely get discussed.”
In the light of the opioid crisis and the mounting evidence for successful behavior strategies for pain management, there is hope that non-pharmaceutical approaches will soon become firmly embedded in integrative pain care.
Content Originally Published by Medical News Today