Reaching Beyond the Prescription Pad to Treat Pain
FRIDAY, June 30, 2017 -- Teaching coping skills may help reduce the risk that patients with chronic pain will become addicted to opioid painkillers, a new study suggests.
"If we lower how many opioids patients are taking, but leave them disabled and not able to live their lives, that is not helpful," said study co-author Dr. Aliza Weinrib, a clinical psychologist in Ontario, Canada.
"Patients can learn to respond to their pain in a different way, making it less overwhelming. They don't have to be so tied to their medications," added Weinrib, who works with surgical patients at Toronto General Hospital.
Many addiction specialists believe widespread use of powerful prescription painkillers led to the current heroin and opioid epidemic ravaging much of North America.
The study included more than 300 patients who developed chronic pain after major surgery -- pain that lasted more than three months and interfered with everyday activities. Many also had major depression and were taking high doses of prescription painkillers, such as OxyContin (oxycodone) and Vicodin (hydrocodone) and morphine.
The patients enrolled in a long-term pain management program at Toronto General Hospital. Those who were willing to taper off their painkillers were referred to a clinical psychologist.
Instead of giving in to their pain, they were encouraged to pursue meaningful life activities, become aware of the thoughts and feelings that accompany pain, and to accept difficult experiences such as pain.
These skills can be taught in three or four sessions. Over two years, they led to significant reductions in opioid use, depression and pain-related disruptions of daily living, according to the study.
"There's the pain in your body, and there's the pain in your heart about not being able to do the things that you love," Weinrib said in a university news release. "We can help people move towards what is important to them, even through their pain. We can help people reduce their pain of not living."
Recent American and Canadian guidelines for managing non-cancer pain suggest trying alternative treatments before considering narcotic painkillers, said study senior author Dr. Hance Clarke.
However, there is little research on how mental health support can help patients manage pain, he said.
This study suggests "there is a powerful role for interventions other than the prescription pad in helping patients manage their pain and suffering, taper their opioids and lead rewarding lives," said Clarke, director of the Transitional Pain Service.
The results were published June 28 in the Canadian Journal of Pain.
The U.S. National Institute of Neurological Disorders and Stroke has more on chronic pain.
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Posted: June 2017