Complementary and Alternative Medicine, Cognitive-Behavioral Therapy Shown To Manage And Reduce Pain Without Opioids
A new European study examined the use of complementary and alternative medicine and found that some approaches are often being employed to treat a variety of health conditions, such as back pain and headaches – especially when that patient is unsatisfied with the efficacy of conventional medicine. Other research suggests that cognitive-behavioral therapy may also be effective.
A collaboration of the Universities of Helsinki, Tampere, and Turku conducted the first study, which revealed that women and people with higher education use forms of complementary and alternative medicine more frequently than others.
Data were collected from over 20 countries and included around 40,000 participants. Four types treatments were examined: Asian, alternative medicine, manual therapies, and mind-body therapies.
Asian treatments include Chinese medicine, acupuncture, and acupressure. Alternative medicine consists of homeopathy and herbal remedies.
In manual therapies, massage, reflexology, osteopathy, and chiropractic services are employed. Mind-body therapies include hypnosis and spiritual healing.
Researchers found that more than one-in-four participants in the study population had used complementary and alternative medicine and treatments in the past year. The most common forms used were massage (12 percent), homeopathy (6%), osteopathy (5%), and herbal remedy (5%). Most subjects had used only one type of treatment.
From the study:
“In total, 25.9% of the general population had used CAM during the last 12 months. Typically, only one CAM treatment had been used, and it was used more often as complementary rather than alternative treatment.”
Treatment prevalence varied widely between the countries of study. For example, in Germany, nearly 40 percent of the study group had employed forms of complementary and alternative medicine, while in Hungary that share was only 10%. The authors also noted that the use of these therapies was 2-4 times greater among those with health problems.
The authors believe that variation of use among countries was related to “socioeconomic inequalities in health service use.”
While European countries do not use opioids at the high rates of Americans, it logically follows that if these these therapies can help ease pain conditions, increasing the employment of such treatments in the U.S. could hlep combat the opioid epidemic.
Cognitive-Behavioral Therapy For Chronic Pain
Another study published in the Journal of Psychiatric Practice found that cognitive-behavioral therapy (CBT) can be an effective treatment alternative for people taking opioids for con-cancer pain.
CBT, a form of psychotherapy, can teach patients strategies for dealing with chronic pain.
From the abstract:
“CBT improves pain-related outcomes along with mobility, quality of life, and disability and mood outcomes.”
The increasing use of opioid painkillers to treat chronic pain has been deemed one of the leading causes of the current opioid epidemic in the U.S. And yet, despite the widespread use, there has been minimal change in the amount and severity of pain that Americans report experiencing. The authors state:
“For the past two decades, long-term opioid analgesic therapy was considered the cornerstone of effective pain management for chronic nonmalignant conditions, despite a lack of documented effectiveness and safety, with the attendant risk of addiction, overdose, and death.”
The researchers posit that CBT may be an important substitute for opioids for chronic pain therapy. CBT helps the patient understand that pain causes stress, but is a stressor with which they can adapt to and cope. CBT interventions can include relaxation techniques, cognitive restructuring, and guided exercise.
According to the authors, these interventions “have the potential to relieve pain intensity, improve the quality of life, and improve physical and emotional function.”
The authors point out multiple recent studies and reviews that support the efficacy of CBT and other alternative treatments for chronic pain. Research suggests that CBT can normalize reductions in the gray matter volume in the brain, a result of the effects of chronic stress.
CBT has been found to be moderately effective at reducing patients’ pain scores while reducing the risk of abuse, addiction, and overdoses related to the use of painkillers:
“Compared with long-term use of opioids, CBT has dramatically lower risks and may, therefore, be worth pursuing.”
CBT may be used as a standalone treatment, or as part of a more comprehensive plan, which may also include non-opioid medication and conventional or alternative therapies and medicine.
CBT may also be used to increase a patient’s ability to reduce opioid doses while continuing to manage chronic pain. Unfortunately, CBT and other non-drug approaches are often underused due to patient demands, the easy of opioid prescribing, and low insurance reimbursement rates.
The authors stress that significant investments in resources will be required to train practitioners and to widely incorporate the use of CBT therapy into the management of chronic pain.
The authors also state that there is a need for a “paradigm shift from a biomedical to biopsychosocial model” for effective pain management and the prevention of opioid abuse, and that use of CBT is lieu of opioids may help “ease the clinical, financial, and social burden of pain disorders on society.”
~ G. Nathalee Serrels, M.A., Psychology