By Shoba Sreenivasan, Ph.D. and Linda E. Weinberger, Ph.D.
A patient in chronic pain wants their pain gone. Perhaps this is easier said than done. Pain management is complex and has no certain or easy solutions. Surgery may not improve, or may even exacerbate, the pain (e.g., as in low back pain). Non-opioid pharmacological treatments may also prove less than satisfactory. Chronic pain causes emotional pain; which, ironically, can result in heightening the patient’s sensitivity to their physical pain. The debilitating effects of chronic pain span across physical, emotional, social, and occupational functioning. In its 2014 report, The National Institutes of Health (NIH) Office of Disease Prevention estimated that chronic pain impacted one-third, or 100 million Americans. It has a high cost: via lost work and medical expenses. The dollar cost was estimated by NIH at $560 to $630 billion a year.
The use of opioids may lessen pain in the short-term, but long-term use remains problematic. For example, it may produce a chronic pain state, may potentiate abuse, and may deepen depression. Moreover, the side-effects of opioids alone, or in combination with other drugs (prescribed or illicit), or if misused by persons with co-morbid conditions (e.g., sleep apnea), can range anywhere from sedation to respiratory suppression to liver damage to death.
Thus, alternate strategies to opioids for pain management have been developed. These include approaches focusing on psychosocial factors, including psychotherapy (such as cognitive-behavioral treatments to address distorted thinking, mindfulness treatment to reframe pain, acceptance commitment therapy to augment psychological flexibility) meditation, yoga, aromatherapy, and acupuncture. These modalities have gained prominence as complementary to traditional medical interventions. These methods have support in the form of small to moderate effect sizes in meta-analytic studies. [Read more…]