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==Overview==
=Cognitive Behavioral Therapy=
A [[randomized controlled trial]] found a reduction in pain and disability although no reduction in opioid use<ref name="pmid34724405">{{cite journal| author=DeBar L, Mayhew M, Benes L, Bonifay A, Deyo RA, Elder CR | display-authors=etal| title=A Primary Care-Based Cognitive Behavioral Therapy Intervention for Long-Term Opioid Users With Chronic Pain : A Randomized Pragmatic Trial. | journal=Ann Intern Med | year= 2021 | volume=  | issue=  | pages=  | pmid=34724405 | doi=10.7326/M21-1436 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34724405  }} </ref>. The intervention includes [https://www.acpjournals.org/doi/suppl/10.7326/M21-1436/suppl_file/M21-1436_Supplement.pdf 12 modules of learning coping skills]. The modules include:
#  Understanding pain/pain education and role of pain coping skills
# Applying progressive muscle relaxation (PMR) and adaptation model.
# Activity-rest cycle
# Pleasant activity scheduling
# Relaxation mini-practices
# Pleasant imagery
# Emotional regulation: leaning in
# Emotional regulation: leaning out
# Cognitive restructuring
# Use of calming self-statements
# Problem-solving/reinforcing the application of learned skills
# Relapse prevention and maintenance enhancement training


==Medical Therapy==
=Rehabilitation=
Opioids are effective for short term use (1-16 weeks)<ref name="pmid17909211">{{cite journal| author=Chou R, Huffman LH, American Pain Society. American College of Physicians| title=Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. | journal=Ann Intern Med | year= 2007 | volume= 147 | issue= 7 | pages= 505-14 | pmid=17909211 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17909211  }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18364420 Review in: Evid Based Nurs. 2008 Apr;11(2):50] </ref>.
{{see|Physical medicine and rehabilitation}}
 
As alluded to earlier there are other modalities used in the treatment of chronic pain. These include: physical modalities such as thermal agents and [[electrotherapy]]. Complementary and alternative medicine, therapeutic exercise and behavioral therapy are also utilized autonomously or in tandem with interventional techniques and conventional pharmacotherapy. This is most often structured in a multidisciplinary or interdisciplinary program.<ref name="Geertzen JH, Van Wilgen CP.">{{cite journal |author=Geertzen JH, Van Wilgen CP, Schrier E, Dijkstra PU |title=Chronic pain in rehabilitation medicine |journal=Disability and rehabilitation |volume=28 |issue=6 |pages=363-7 |year=2006 |pmid=16492632}}</ref>
For chronic, non-cancer pain, opioids may give ''short term reduction'' in pain compared to placebo.<ref name="pmid15561393">{{cite journal |author=Kalso E, Edwards JE, Moore RA, McQuay HJ |title=Opioids in chronic non-cancer pain: systematic review of efficacy and safety |journal=Pain |volume=112 |issue=3 |pages=372–80 |year=2004 |pmid=15561393 |doi=10.1016/j.pain.2004.09.019 |url=http://linkinghub.elsevier.com/retrieve/pii/S0304-3959(04)00447-6}}</ref><ref name="pmid17227935">{{cite journal| author=Martell BA, O'Connor PG, Kerns RD, Becker WC, Morales KH, Kosten TR et al.| title=Systematic review: opioid treatment for chronic back pain: prevalence, efficacy, and association with addiction. | journal=Ann Intern Med | year= 2007 | volume= 146 | issue= 2 | pages= 116-27 | pmid=17227935 | url=http://www.annals.org/content/146/2/116.full}} </ref><ref name="pmid16717269">{{cite journal |author=Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E |title=Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects |journal=CMAJ |volume=174 |issue=11 |pages=1589–94 |year=2006 |pmid=16717269 |doi=10.1503/cmaj.051528 |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=16717269}}</ref> The role of ''long term treatment'' of chronic non-cancer pain is not clear and a [[systematic review]] by the [[Cochrane Collaboration]] found "weak evidence suggests that patients who are able to continue opioids long-term experience clinically significant pain relief. Whether quality of life or functioning improves is inconclusive."<ref name="pmid20091598">{{cite journal| author=Noble M, Treadwell JR, Tregear SJ, Coates VH, Wiffen PJ, Akafomo C et al.| title=Long-term opioid management for chronic noncancer pain. | journal=Cochrane Database Syst Rev | year= 2010 | volume=  | issue= 1 | pages= CD006605 | pmid=20091598 | doi=10.1002/14651858.CD006605.pub2 }} </ref>
 
One [[systematic review]] found that trials of short term opioids did not improve functional status compared to placebo in chronic pain.<ref name="pmid15561393">{{cite journal |author=Kalso E, Edwards JE, Moore RA, McQuay HJ |title=Opioids in chronic non-cancer pain: systematic review of efficacy and safety |journal=Pain |volume=112 |issue=3 |pages=372–80 |year=2004 |pmid=15561393 |doi=10.1016/j.pain.2004.09.019 |url=http://linkinghub.elsevier.com/retrieve/pii/S0304-3959(04)00447-6}}</ref> However, a second [[systematic review]], found that opioids improved functional status compared to placebo, but not compared to other drugs.<ref name="pmid16717269">{{cite journal |author=Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E |title=Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects |journal=CMAJ |volume=174 |issue=11 |pages=1589–94 |year=2006 |pmid=16717269 |doi=10.1503/cmaj.051528 |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=16717269}}</ref>
 
As example [[randomized controlled trial]]s, opioids reduced pain in the short term, but did not improve function in comparison to an [[cholinergic antagonist]] placebo<ref name="pmid8544547">{{cite journal| author=Moulin DE, Iezzi A, Amireh R, Sharpe WK, Boyd D, Merskey H| title=Randomised trial of oral morphine for chronic non-cancer pain. | journal=Lancet | year= 1996 | volume= 347 | issue= 8995 | pages= 143-7 | pmid=8544547 }} </ref> or [[tricyclic antidepressant]].<ref name="pmid12370455">{{cite journal| author=Raja SN, Haythornthwaite JA, Pappagallo M, Clark MR, Travison TG, Sabeen S et al.| title=Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial. | journal=Neurology | year= 2002 | volume= 59 | issue= 7 | pages= 1015-21 | pmid=12370455 | doi= | pmc= | url= }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12841962 Review in: J Fam Pract. 2003 Jul;52(7):517-8] </ref>
 
Most trials are funded by industry.<ref name="pmid16717269">{{cite journal |author=Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E |title=Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects |journal=CMAJ |volume=174 |issue=11 |pages=1589–94 |year=2006 |pmid=16717269 |doi=10.1503/cmaj.051528 |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=16717269}}</ref>


==References==
==References==

Latest revision as of 14:54, 12 November 2021

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Robert G. Badgett, M.D.[1]

Cognitive Behavioral Therapy

A randomized controlled trial found a reduction in pain and disability although no reduction in opioid use[1]. The intervention includes 12 modules of learning coping skills. The modules include:

  1. Understanding pain/pain education and role of pain coping skills
  2. Applying progressive muscle relaxation (PMR) and adaptation model.
  3. Activity-rest cycle
  4. Pleasant activity scheduling
  5. Relaxation mini-practices
  6. Pleasant imagery
  7. Emotional regulation: leaning in
  8. Emotional regulation: leaning out
  9. Cognitive restructuring
  10. Use of calming self-statements
  11. Problem-solving/reinforcing the application of learned skills
  12. Relapse prevention and maintenance enhancement training

Rehabilitation

Further information: Physical medicine and rehabilitation

As alluded to earlier there are other modalities used in the treatment of chronic pain. These include: physical modalities such as thermal agents and electrotherapy. Complementary and alternative medicine, therapeutic exercise and behavioral therapy are also utilized autonomously or in tandem with interventional techniques and conventional pharmacotherapy. This is most often structured in a multidisciplinary or interdisciplinary program.[2]

References

  1. ↑ DeBar L, Mayhew M, Benes L, Bonifay A, Deyo RA, Elder CR; et al. (2021). "A Primary Care-Based Cognitive Behavioral Therapy Intervention for Long-Term Opioid Users With Chronic Pain : A Randomized Pragmatic Trial". Ann Intern Med. doi:10.7326/M21-1436. PMID 34724405 Check |pmid= value (help).
  2. ↑ Geertzen JH, Van Wilgen CP, Schrier E, Dijkstra PU (2006). "Chronic pain in rehabilitation medicine". Disability and rehabilitation. 28 (6): 363–7. PMID 16492632.


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