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Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis.
Eric L Garland1,2, Carrie E Brintz3, Adam W Hanley1,2
1Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City.
JAMA Internal Medicine
|November 5, 2019
Summary
Mind-body therapies (MBTs) show moderate pain reduction and small opioid dose decreases in patients. These therapies may also help with opioid craving and misuse, offering potential benefits for the opioid crisis.
Area of Science:
- Integrative Medicine
- Pain Management
- Addiction Research
Background:
- Mind-body therapies (MBTs) are increasingly recognized for their potential role in addressing the opioid crisis.
- Understanding the efficacy of MBTs for patients on opioid therapy for various pain conditions is crucial for healthcare providers, policymakers, and patients.
Purpose of the Study:
- To systematically evaluate the association between MBTs and reductions in pain intensity and opioid dosage among adults with clinical pain.
- To synthesize evidence from randomized clinical trials and systematic reviews on MBT effectiveness in pain and opioid management.
Main Methods:
- A comprehensive systematic review and meta-analysis was conducted, searching multiple databases (MEDLINE, Embase, etc.) for relevant English-language studies up to March 2018.
- Included studies were randomized clinical trials assessing MBTs in adults prescribed opioids for pain.
- Data extraction and risk of bias assessment were performed by independent reviewers, with meta-analyses using standardized mean differences for pain and opioid dose.
Main Results:
- The meta-analysis included 60 reports with 6404 participants, revealing that MBTs were associated with moderate pain reduction (Cohen's d = -0.51) and small opioid dose reductions (Cohen's d = -0.26).
- Specific MBTs like meditation, hypnosis, therapeutic suggestion, and cognitive behavioral therapy demonstrated moderate to large effect sizes for pain improvement.
- While most studies on meditation, cognitive behavioral therapy, and hypnosis reported improved opioid-related outcomes, fewer studies on suggestion, guided imagery, and relaxation showed similar benefits.
Conclusions:
- MBTs are associated with significant improvements in pain intensity and modest reductions in opioid dose.
- The findings suggest MBTs may offer therapeutic advantages for opioid-related issues, including craving and misuse.
- Further research is recommended to precisely quantify opioid dosing variables and confirm the association between MBTs and opioid-related outcomes.
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