Reduce Opioid-Treated Pain and Opioid Dosage with Mindfulness
By John M. de Castro, Ph.D.
“Mind-body therapies — including meditation, cognitive behavioral therapy and hypnosis — were associated with improvements in pain and reduced opioid doses.” – Erin Michael
We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.
There is an accumulating volume of research findings that demonstrate that mindfulness practices, in general, are effective in treating pain. What is not known is the most effective mind-body treatments for chronic pain. There are a large variety of mind-body therapies including meditation, hypnosis, relaxation, guided imagery, therapeutic suggestion, and Cognitive Behavioral Therapy (CBT). It is not known which are the most effective for reducing pain and opioid use in patients with chronic pain who are being treated with opioids.
In today’s Research News article “Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830441/ ) Garland and colleagues review, summarize, and perform a meta-analysis of the published randomized controlled trials of the effectiveness of mind-body techniques for opioid-treated pain. They identified 60 published trials.
They report that the published research found that the studies that used Mind-Body Therapies produced significant reductions in pain outcomes and opioid use. This was true for studies that employed meditation, hypnosis, or Cognitive Behavioral Therapy (CBT), with the largest effect sizes found for meditation. Suggestion, imagery, and relaxation were all found to be less effective.
Hence, the published randomized controlled trials support the use of Mind-Body Therapies for the treatment of patients with chronic pain who are being treated with opioids. Meditation, hypnosis, or Cognitive Behavioral Therapy (CBT) are particularly effective in both treating pain and reducing opioid use. This is compatible with other results that mindfulness meditation has been repeatedly shown to reduce pain and improve recovery from opioid addiction.
Meditation, hypnosis, or Cognitive Behavioral Therapy (CBT) have a common property of changing the patient’s thought patterns associated with their pain and thereby alter their relationship with the pain. These thought patterns such as worry, rumination, and catastrophizing tend to amplify the physical pain. Reducing these tendencies can eliminate the amplification and thereby reduce the experienced pain. With less pain, less opioids are needed to control it.
So, reduce opioid-treated pain and opioid dosage with mindfulness.
“Using mindfulness, meditation, hypnosis, therapeutic suggestion, and cognitive behavior therapy, in addition to opioid treatment of acute or chronic pain, provides an additional benefit to patients by reducing pain scores. Some of these interventions will decrease the duration or amount of opioid needed.” – Sumi Sexton
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Garland, E. L., Brintz, C. E., Hanley, A. W., Roseen, E. J., Atchley, R. M., Gaylord, S. A., Faurot, K. R., Yaffe, J., Fiander, M., & Keefe, F. J. (2019). Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis. JAMA internal medicine, 180(1), 91–105. Advance online publication. https://doi.org/10.1001/jamainternmed.2019.4917
Key Points
Question
Are mind-body therapies (ie, meditation, hypnosis, relaxation, guided imagery, therapeutic suggestion, and cognitive behavioral therapy) associated with pain reduction and opioid-related outcome improvement among adults using opioids for pain?
Findings
In this systematic review and meta-analysis of 60 randomized clinical trials with 6404 participants, mind-body therapies were associated with improved pain (Cohen d = −0.51; 95% CI, −0.76 to −0.27) and reduced opioid dose (Cohen d = −0.26; 95% CI, −0.44 to −0.08).
Meaning
Practitioners should be aware that mind-body therapies may be associated with moderate improvements in pain and small reductions in opioid dose.
Abstract
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.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830441/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.