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Question clinique
Are mind-body therapies, including meditation, hypnosis, and relaxation, effective to decrease pain or affect opioid use in patients with acute or chronic pain?
L’Essentiel
Using mindfulness meditation, hypnosis, therapeutic suggestion, and cognitive behavioral therapy, in addition to opioid treatment of either acute or chronic pain, provides an additional benefit to patients by reducing pain scores. Some of these interventions will decrease either the duration or amount of opioid needed. 1a
Référence
Plan de l'etude: Meta-analysis (randomized controlled trials)
Financement: Government
Cadre: Various (meta-analysis)
Sommaire
To assemble randomized controlled trials to combine for this meta-analysis, the researchers searched 6 databases, including the Cochrane Library, for English-language articles on mind-body therapies. They also searched bibliographies of retrieved articles and the websites of the Agency for Health Care Quality and Research, American Psychological Association, and the World Health Organization. Two authors independently selected studies for inclusion, extracted the data, and assessed the risk of bias. They identified 60 studies of 6404 participants that evaluated mind-body approaches on procedural pain, burn pain, cancer pain, and chronic pain. Most studies were at low risk of bias because of their designs. Pain intensity was reduced by a moderate to large amount with meditation (mindfulness), hypnosis, therapeutic suggestion (suggestions to change thoughts, emotions, or sensations without inducing hypnosis), and cognitive behavioral therapy. In addition, meditation, cognitive behavioral therapy, and hypnosis also decreased opioid-related outcomes such as opioid misuse, opioid craving, and time to opioid cessation (acute pain). There was a high degree of heterogeneity among the studies regarding the size of the effect. Studies that did not show benefit of meditation and therapeutic suggestion may have not have been published (ie, publication bias may have occurred, amplifying the actual benefit of these approaches).
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Commentaires
Keep them coming
Great POEM. Appreciate seeing more of these mind-body treatment studies, especially in addiction/chronic pain domains of care. Thank you