Mind-body therapies linked to improved pain, lower opioid dose
Mind-body therapies — including meditation, cognitive behavioral therapy and hypnosis — were associated with improvements in pain and reduced opioid doses, according to a study published in JAMA Internal Medicine.
“Mind-body therapies may be useful for reducing pain and opioid use to prevent the development of opioid misuse and addiction,” Eric Garland, PhD, LCSW, distinguished endowed chair in research at the University of Utah College of Social Work, told Healio Primary Care.
In addition, he explained, mind-body therapies “can be used to directly treat opioid misuse and opioid use disorder among people with chronic pain, as recent clinical trials have demonstrated.”
Garland and colleagues conducted a systematic review and meta-analysis of randomized clinical trials and other systematic reviews on mind-body therapies (MBT) and their effect on pain and opioids published through March 2018.
A total of 60 studies involving 6,404 participants were included in the final analysis. The types of MBT assessed in the studies were hypnosis (n = 25), relaxation (n = 14), CBT (n = 7), guided imagery (n = 7), therapeutic suggestion (n = 6) and meditation (n = 5).
Researchers found that MBTs were associated with reductions in pain (Cohen d = 0.51; 95% CI, 0.76 to 0.26) and opioid dose (Cohen d = 0.26; 95% CI, 0.44 to 0.08).
They identified moderate-to-large improvements in pain outcomes for meditation (Cohen d = 0.7), hypnosis (Cohen d = 0.54), suggestion (Cohen d = 0.68, and CBT (Cohen d = 0.43).
Most studies that evaluated hypnosis, CBT and meditation showed improvements in opioid-related outcomes. Fewer studies assessing suggestion, guided imagery and relaxation found that they improved opioid-related outcomes.
Garland told Healio Primary Care that the findings suggest that “physicians should refer patients receiving opioids for pain conditions to mind-body therapies like mindfulness meditation and CBT.”
However, he noted that as long as these therapies are “only delivered off-site in special boutique settings as an alternative health intervention, they will never be widely adopted.”
“In my utopian vision of the future, if a primary care physician decides to prescribe an opioid medication, the physician would also prescribe a mind-body therapy and possibly also an exercise and nutrition program,” with an integrative medicine approach included in the treatment plan, Garland explained.
“This could prevent a lot of patient problems and suffering down the line,” he said. “Such an integrative approach might even prevent acute pain from becoming chronic pain. – by Erin Michael
Disclosures: Please see study for all authors’ relevant financial disclosures.