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Medication, hypnosis, therapeutic suggestion, and CBT can decrease pain and opioid use
Question clinique
Can mind-body approaches decrease pain or affect opioid use?
L’Essentiel
Broadly speaking, mind-body therapies such as meditation, hypnosis, therapeutic suggestion, and cognitive behavioral therapy (CBT) can decrease reports of pain and decrease opioid use or opioid dose for patients with acute or chronic pain or pain due to a procedure, burns, or cancer. Using these modalities is inexpensive and low risk. 1a
Référence
Plan de l'etude: Meta-analysis (randomized controlled trials)
Financement: Government
Cadre: Various (meta-analysis)
Sommaire
Mind-body therapies are approaches in which a person's mind is used to affect physical functioning and to promote health. The authors limited their search to meditation, hypnosis, guided imagery, relaxation, therapeutic suggestion (using positive messages), and CBT. They identified 60 studies of 6404 patients by searching 6 databases, including Cochrane CENTRAL, for English-language randomized clinical trials and systematic reviews. Two researchers independently selected articles for inclusion, abstracted the data, and assessed study quality. They did not find evidence of publication bias (that is, evidence of unpublished studies that failed to show benefit). Many of the studies are older and some have threats to validity. Most studies (n = 39) focused on procedural pain but the rest of the studies evaluated these approaches to treatment in patients with burn pain, cancer pain, chronic pain, or acute pain. Hypnosis was the most frequently studied approach. Overall, mind-body treatments were associated with moderate reduction in pain (standardized mean difference -0.51; 95% CI -0.76 to -0.26) and lowered opioid dose (standardized mean difference -0.26; -0.44 to -0.08). Meditation, hypnosis, therapeutic suggestion, and CBT produced modest to large effects on pain. Meditation affected opioid-related outcomes such as opioid misuse, opioid craving, and duration of treatment but there was not a consistent effect on reducing opioid use. Hypnosis was associated with lower use of opioids or a reduction in opioid dose. Some, but not all, studies of therapeutic suggestion found a moderate reduction in pain intensity and a reduction of opioid dose. CBT was associated with a moderate reduction in pain and a reduction in opioid dose, use, or misuse.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Commentaires
Subject Heading Error?
Greetings, my great contribution to POEM academia would appear to be that pointing out that while the topic of this POEM is the benefit of "mindfulness" in pain, the subject heading says instead "medication"... which the body of the article actually says was decreased... nor does the title even mention medication... error?
CBT, meditation and hypnotherapy
Use in addition, pain etc.