Psychotherapeutic interventions for chronic pain: Evidence, rationale, and advantages (original) (raw)
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Journal of Consulting and Clinical Psychology, 2014
Objective: Opioid pharmacotherapy is now the leading treatment for chronic pain, a problem that affects nearly one-third of the United States population. Given the dramatic rise in prescription opioid misuse and opioid-related mortality, novel behavioral interventions are needed. The purpose of this study was to conduct an early stage randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), a multimodal intervention designed to simultaneously target mechanisms underpinning chronic pain and opioid misuse.
Comorbid Pain and Opioid Addiction: Psychosocial and Pharmacological Treatments
Substance Use & Misuse, 2011
Treating comorbid pain (nonmalignant) and opioid addiction is a complex endeavor that requires cooperation of multi-modal treatment teams incorporating pharmacological, psychological, and social components. There are multiple barriers for patients, mental health practitioners, and physical health practitioners to provide complete treatment for this difficult treatment population. In this article, we will review which treatments have been empirically validated in this treatment population, where further research is required, and considerations for potential "best approaches" to use for patient treatment while waiting for empirically validated treatment data. We will also discuss some complementary and alternative medicine approaches that have empirical validity in treating either pain or addiction individually, though empirical validity for the treatment of comorbid pain and addiction has not been established.
Review Paper Chronic Pain and Psychological Interventions: A Systematic Review
The Iranian Journal of Neurosurgery, 2023
Background and Aim: Chronic pain is an emotional experience with unpleasant psychological consequences for individuals and society. This research aims to systematically review the psychological interventions implemented in people suffering from chronic pain. Methods and Materials/Patients: In this systematic review, the following keywords were searched in PubMed, Scopus, and Google Scholar databases: Chronic pain, psychological interventions, psychotherapy, psychology, clinical trials, and randomized clinical trials. The time span for the search was from January 2018 to December 2022. From a total of 2785 articles, 20 articles by 2078 contributors were selected for this review. Results: Cognitive behavioral therapy ranks first among psychological interventions for people with chronic pain. Also, to improve the quality of life and psychological health of these individuals from other psychological interventions, such as acceptance and commitment therapy, the mindfulness method has been used. This treatment has been effective in relieving pain, controlling pain, reducing stress and depression, and improving the quality of life. Using a randomized controlled trial design and follow-up were the strengths of these studies. Conclusion: The findings suggest that psychological interventions had the greatest impact on pain relief, quality of life, depression, and stress, respectively. Accordingly, it is proposed to use psychological interventions in addition to medical treatment.
Primary Care: Clinics in Office Practice, 2016
Treating patients with chronic pain has become increasingly difficult for primary care physicians. In 2011, the Institute of Medicine (IOM) reported that pain affects an estimated 100 million Americans and has become more common than many chronic conditions, including diabetes, coronary heart disease, stroke, and cancer (Table 1). 1-3 At the same time, the number of prescriptions for pain medications has been increasing, as well as the number of subsequent deaths associated with overdose and drug interactions (Fig. 1). During this period of rapid growth in narcotic use, the prevalence of chronic pain has remained stable since 2006, forcing physicians to realize that the fault Disclosures: The author has nothing to disclose, and has received no financial compensation for writing this article. Red Bud Clinic Corporation,
Chronic Pain and Psychological Interventions: A Systematic Review
Iranian Journal of Neurosurgery
Background and Aim: Chronic pain is an emotional experience with unpleasant psychological consequences for individuals and society. This research aims to systematically review the psychological interventions implemented in people suffering from chronic pain. Methods and Materials/Patients: In this systematic review, the following keywords were searched in PubMed, Scopus, and Google Scholar databases: Chronic pain, psychological interventions, psychotherapy, psychology, clinical trials, and randomized clinical trials. The time span for the search was from January 2018 to December 2022. From a total of 2785 articles, 20 articles by 2078 contributors were selected for this review. Results: Cognitive behavioral therapy ranks first among psychological interventions for people with chronic pain. Also, to improve the quality of life and psychological health of these individuals from other psychological interventions, such as acceptance and commitment therapy, the mindfulness method has bee...
Psychological therapies for the management of chronic pain
Psychology Research and Behavior Management, 2014
Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. However, psychological therapies for chronic pain differ in their scope, duration, and goals, and thus show distinct patterns of treatment efficacy. These therapies fall into four categories: operantbehavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. The current article explores the theoretical distinctiveness, therapeutic targets, and effectiveness of these approaches as well as mechanisms and individual differences that factor into treatment response and pain-related dysfunction and distress. Implications for future research, dissemination of treatment, and the integration of psychological principles with other treatment modalities are also discussed.
Psychologic interventions for chronic pain
Physical medicine and rehabilitation clinics of North America, 2006
As a biopsychosocial understanding of chronic pain has become more sophisticated during recent decades, a variety of psychologically based treatment approaches have been developed and empirically validated for helping people better manage their pain. These approaches to pain management have much to offer persons with chronic pain in terms of enhancing quality of life and pain-related coping, as well as reducing disability and pain-related interference with functioning. Although some treatments, like hypnotic analgesia, may require referral to a specialized provider, several of the principles of other psychologically based treatment approaches for pain management (eg, operant behavioral therapy, cognitive-behavioral therapy, motivational interviewing) can easily be integrated into work with persons with pain in a rehabilitation setting. Rehabilitation providers who are interested in incorporating these treatment strategies into their clinical work who do not have prior exposure to th...
Contemporary Clinical Trials, 2020
This randomized trial will evaluate the mechanisms of three chronic pain treatments: cognitive therapy (CT), mindfulness meditation (MM), and activation skills (AS). We will determine the extent to which late-treatment improvement in primary outcome (pain interference) is predicted by early-treatment changes in cognitive content, cognitive process, and/or activity level. The shared versus specific role of these mechanisms across the three treatments will be evaluated during treatment (Primary Aim), and immediately post-treatment to examine relapse mechanisms (Secondary Aim). We will enroll 300 individuals with chronic pain (with low back pain as a primary or secondary condition), with 240 projected to complete the study. Participants will be randomly assigned to eight, 1.5 h telehealth group sessions of CT, MM, or AS. Mechanisms and outcomes will be assessed twice daily during 2-week baseline, 4week treatment period, and 4-week post-treatment epoch via random cue-elicited ecological momentary assessment (EMA); activity level will be monitored during these time epochs via daily monitoring with ActiGraph technology. The primary outcome will be measured by the PROMIS 5-item Pain Interference scale. Structural equation modeling (SEM) will be used to test the primary aims. This study is pre-registered on clinicaltrials.gov (Identifier: NCT03687762). This study will determine the temporal sequence of lagged mediation effects to evaluate rates of change in outcome as a function of change in mediators. The findings will provide an empirical basis for enhancing and streamlining psychosocial chronic pain interventions. Further, results will guide future efforts towards optimizing maintenance of gains to effectively reduce relapse risk.
Mind-Body Therapies for Opioid-Treated Pain
JAMA Internal Medicine
IMPORTANCE Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients. OBJECTIVE To evaluate the association of MBTs with pain and opioid dose reduction in a diverse adult population with clinical pain. DATA SOURCES For this systematic review and meta-analysis, the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases were searched for English-language randomized clinical trials and systematic reviews from date of inception to March 2018. Search logic included (pain OR analgesia OR opioids) AND mind-body therapies. The gray literature, ClinicalTrials.gov, and relevant bibliographies were also searched. STUDY SELECTION Randomized clinical trials that evaluated the use of MBTs for symptom management in adults also prescribed opioids for clinical pain. DATA EXTRACTION AND SYNTHESIS Independent reviewers screened citations, extracted data, and assessed risk of bias. Meta-analyses were conducted using standardized mean differences in pain and opioid dose to obtain aggregate estimates of effect size with 95% CIs. MAIN OUTCOMES AND MEASURES The primary outcome was pain intensity. The secondary outcomes were opioid dose, opioid misuse, opioid craving, disability, or function. RESULTS Of 4212 citations reviewed, 60 reports with 6404 participants were included in the meta-analysis. Overall, MBTs were associated with pain reduction (Cohen d = −0.51; 95% CI, −0.76 to −0.26) and reduced opioid dose (Cohen d = −0.26; 95% CI, −0.44 to −0.08). Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and cognitive behavioral therapy (n = 7) interventions. Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d = −0.70), hypnosis (Cohen d = −0.54), suggestion (Cohen d = −0.68), and cognitive behavioral therapy (Cohen d = −0.43) but not for other MBTs. Although most meditation (n = 4 [80%]), cognitive-behavioral therapy (n = 4 [57%]), and hypnosis (n = 12 [63%]) studies found improved opioid-related outcomes, fewer studies of suggestion, guided imagery, and relaxation reported such improvements. Most MBT studies used active or placebo controls and were judged to be at low risk of bias. CONCLUSIONS AND RELEVANCE The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse. Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes.