Mind-body therapies for opioid-treated pain

Mind-body therapies for opioid-treated pain

A new study published Nov. 4, 2019, in the journal JAMA Internal Medicine details the first comprehensive look across the scientific literature at the role of mind-body therapies in addressing opioid-treated pain.

The researchers found that certain mind-body therapies can reduce pain, as well as reduce opioid use, among patients treated with prescription opioids.

These findings are critical for medical and behavioral health professionals as they work with patients to determine the best and most effective treatments for pain.”

Eric Garland, lead author on the study explained that mind-body therapies focus on changing behavior and the function of the brain with the goal of improving quality of life and health.

Mind-body therapies include clinical use of meditation/mindfulness, hypnosis, relaxation, guided imagery, therapeutic suggestion and cognitive-behavioral therapy.

The researchers examined over 4,200 articles to identify 60 previously published randomized controlled trials on psychologically oriented mind-body therapies for opioid-treated pain.

The randomized controlled trials included in the study involved more than 6,400 study participants.

The research team looked at the type of pain experienced by the study participants, the type of mind-body therapy used and its effect on the severity of pain and the use or misuse of opioids.

They found that meditation/mindfulness, hypnosis, therapeutic suggestion and cognitive-behavioral therapy all demonstrated significant improvements in pain severity.

They also found that the majority of the meditation/mindfulness, therapeutic suggestion and cognitive-behavioral therapy studies showed improvements in opioid use or misuse. In contrast, two studies utilizing relaxation found significantly worsened results in opioid dosing.

Notably, mind-body therapies seem to be effective at reducing acute pain from medical procedures, as well as chronic pain.

The researchers highlighted this as an important finding, as mind-body therapies could be easily integrated into standard medical practice and could potentially prevent chronic use of opioids and opioid use disorder.

Since mind-body therapies primarily use mental techniques and can continue to be utilized by patients after formal treatment, they may be more easily-accessible than other treatments.

The researchers also concluded that two of the mind-body therapies examined, meditation/mindfulness and cognitive-behavioral therapy, might have the highest clinical impact, since they are so widely accessible and affordable.

“A study published earlier this year projected that by 2025, some 82,000 Americans will die each year from opioid overdose,” said Garland.

“Our research suggests that mind-body therapies might help alleviate this crisis by reducing the amount of opioids to cope with pain. If doctors, nurses, social workers, policymakers, insurance companies and patients use this evidence as we make decisions, we can help stem the tide of the opioid epidemic.”

Reviewed by: Kate Anderton

Science pushes for non-substance therapies

Science pushes for non-substance therapies

A meta-analysis examines treatments like meditation and cognitive behavioral therapy as alternatives for alleviating pain that is typically treated with opioids.

The more we learn about opioids, the clearer it becomes that there’s no simple solution to the opioid crisis and the cycle of dependency and misuse that has already impacted millions of Americans.

It’s especially difficult given how effective opioids are at pain management, particularly the kind of acute, short-term pain associated with cancer treatment or surgical or injury recovery.

Researchers are actively seeking alternatives to opioids when it comes to pain management—and a meta-study tracking the efficacy of mind-body therapies for treating pain that was previously managed with opioids indicates that some MBTs could act as effective pain management treatments, as well as tools for helping reduce opioid use and dependency.

The survey examined 60 studies looking at the effectiveness of “psychologically oriented MBTs,” including meditation, hypnosis, guided imagery, relaxation, cognitive behavioral therapy, and therapeutic suggestion, at pain management and/or opioid use outcomes.

The overview found a moderately significant association between MBTs and pain reduction and a smaller significant association between MBTs and reduction of opioid doses, as well as some relationship between MBTs and the treatment of opioid misuse and cravings.

Meditation was found to have the strongest correlation with pain reduction. The five meditation-related studies reviewed all showed participants experiencing some level of pain relief from the therapeutic treatment.

Four of the five studies also found meditation and mindfulness resulted in “opioid-related outcomes,” including decrease in opioid dosage, decreased cessation time, and dips in opioid misuse and cravings.

Hypnosis and CBT were also associated with positive opioid-related outcomes, with 12 of 23 hypnosis studies and four of the seven CBT studies reviewed showing “significant therapeutic effects” on opioid use.

Eric Garland, the study’s lead author, said his background in social work led him to a better understanding of the relationship between MBTs and pain, as well as the one between MBTs and opioids. “I’m a licensed clinical social worker,” Garland told VICE. “I’ve used mind-body therapies both for the treatment of chronic pain as well as the treatment of addictive behaviors.”

He said opioid misuse, pain, and MBTs all have one major factor in common: the brain. “Mind-body therapies make a lot of sense for the treatment of pain since all pain is in the brain.

If you use a technique that changes the way the brain functions, that changes the way the brain interprets signals from the body and therefore it will affect the experience of pain, as well as the person’s emotional reaction to pain.”

Since long-term opioid use can lead to brain changes like opioid tolerance and a loss of the ability to self-regulate opioid usage, MBTs can play a dual role for someone already using prescription drugs to manage their pain, Garland said.

“[MBTs] are all about teaching people a way to regain some of that control over the function of the brain and so therefore it can be useful not only for reducing the pain and helping the patient manage the pain, but also helping them gain better control over their opioid use itself.”

Does this mean people with opioid use disorder or who are living with pain from other medical procedures can ditch the Oxycontin and just fire up a ‘Yoga with Adrienne’ video? Of course not.

Research has shown that mindfulness and opioids don’t operate on the same parts of the brain, for starters, which means MBTs are a better side-by-side treatment than a ready-made substitute for medication.

The 60 studies surveyed included a total of 6404 participants who were already taking opioids, which averages out to around 100 people per study—a sample group too small to base conclusive solutions on.

Authors were careful to note that different MBTs were applied to different types of pain, with meditation studies tending to target chronic pain while hypnosis, relaxation, therapeutic suggestion and guided imagery treatments were more likely to be applied to acute pain.

Garland also said in the future, he hopes more research will focus on the relationship between MBTs and opioid use, rather than just the relationship between MBTs and pain.

By: Katie Way