Chronic pain relief with behavioral strategies

Mindfulness therapy can provide solutions to move beyond analgesic-based treatments in case of chronic pains. (Photo:

Behavioral strategies that relieve the physical and emotional burdens of chronic pain are becoming more commonplace, not just as alternatives or adjuncts to problematic opioid analgesics, but as effective means to restore daily functioning.

While analgesics can provide welcome relief in acute pain conditions, pain reduction is only temporary and does little to remedy the distress and disabilities that emerge when pain persists.

In fact, a recent study published in the Journal of Pain, examining populations in two large health systems, indicated that increasing the dose and duration of opioids for unrelieved chronic pain was associated with worse health outcomes. Behavioral interventions can successfully interrupt the cycle of treating heightened perception of pain with ever more analgesics. They have also empowered patients to shift the focus from their pain and impairment to reclaiming function and activities, despite residual pain.

What strategies can physicians use to change pain behavior? And why are these treatments not widely adopted in the medical profession?

Various approaches to the treatment chronic pain

The implementation of evidence-based behavioral strategies in managing chronic pain has been advocated by various agencies, such as the National Institutes of Health (NIH) and the Institute of Medicine in the United States.

The principal interventions for relieving the psychological symptoms of chronic pain are cognitive behavioral therapy (CBT) and mindfulness treatments. CBT includes several different strategies, with acceptance and commitment therapy (ACT) being one of them. Each focuses on maladaptive or dysfunctional thinking and responses to stress, while ACT emphasizes acknowledgment and acceptance of these without requiring their resolution before progressing.

Key targets of CBT are reducing "catastrophizing", which is when the patient is feeling helpless and overwhelmed, and identifying "secondary gains" from the impairment of pain, which may undermine motivation to resume work or interact with family or peers. CBT can also increase both self-efficacy and the capacity to accept social support, as both are associated with greater tolerance of pain and reduction in perceived pain intensity.

Mindfulness treatments, including mindfulness-based stress reduction, mindfulness-based cognitive therapy, and mindfulness meditation, foster an awareness of the sensation of pain without judgment or emotional response.

"Behavioral treatment strategies for chronic pain have strong, proven efficacy, are cost-effective, and do not have side effects or interactions." Dawn C. Buse, Ph.D., associate professor, Department of Neurology at Albert Einstein College of Medicine, Yeshiva University in New York City

Author: Kenneth J. Bender, Pharm.D., M.A. – 07/2017
Text slightly adapted and abridged
With kind permission to publish from MNT

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