Meditation, CBT May Ease Opioid-Treated Pain

Meditation, cognitive-behavioral therapy (CBT), and other mind-body therapies may help ease pain in patients who take opioid medications for pain, a meta-analysis in JAMA Internal Medicine has found. The meta-analysis, which included 60 studies and more than 6,400 participants, also suggests that mind-body therapies may lower the risk of opioid misuse.

“Given the heightened urgency of the opioid crisis, we need to know if mind-body therapies can be a useful means of reducing the risks associated with opioid use,” said lead author Eric L. Garland, Ph.D., director of the Center on Mindfulness and Integrative Health Intervention Development at the University of Utah College of Social Work.

Garland and his colleagues used data from the studies to look at outcomes such as pain intensity, opioid dose, opioid misuse, and opioid craving. Twenty-five of the studies tested hypnosis, 14 tested relaxation, seven tested guided imagery, seven tested CBT, six tested therapeutic suggestion, and five tested meditation, with some studies testing more than one therapy. Most of the studies looked at pain from medical procedures, with the remainder assessing burn pain, cancer pain, chronic pain, or multiple pain conditions.

Meditation, hypnosis, therapeutic suggestion, and CBT were associated with significant decrease in pain severity. Most of the studies on meditation, CBT, and hypnosis found a significant association between treatment and lower opioid dosing, craving, and misuse. However, relatively few studies of therapeutic suggestion, guided imagery, and relaxation showed an association with these opioid-related outcomes, and two studies of relaxation suggested worsened opioid dosing outcomes for post-procedure pain.

The researchers noted the potential for widespread application of meditation and CBT, writing that these two mind-body therapies “may be particularly useful given their association with reduced pain severity, … their potential to improve opioid-related outcomes, their broad public appeal, and the comparatively larger numbers of practitioners already trained to deliver these modalities.”

Garland said that there is an important place for psychiatrists on multidisciplinary teams that treat patients who have pain.

“Many patients with chronic pain suffer from psychiatric disorders, for example, depression, and many patients with psychiatric disorders also suffer from comorbid chronic pain,” Garland told Psychiatric News. “Psychiatrists can be especially helpful with treating patients with complex medical and psychiatric comorbidities by managing their multiple medications while at the same time providing psychotherapeutic support, including mind-body therapies.”

“[The psychiatrist] is best equipped to deal with the most complex patients for whom mind-body therapies alone are not sufficient,” Garland added. “Mind-body therapies are not a panacea, and some patients may need a combination of psychological and pharmacological treatment, as well as body-oriented approaches like physical therapy, exercise, and nutrition counseling.”

Garland and two of his coauthors were supported by grants from the National Institutes of Health during the preparation of their manuscript. ■

“Mind-Body Therapies for Opioid-Treated Pain: A Systemic Review and Meta-Analysis” is posted here.