Doctors should consider cognitive therapies as potential first-line treatment.
Increasing practitioner skepticism about the long-term safety of opioid pain medications for treating chronic pain and compelling evidence showing the benefits of cognitive-based therapies are convincing more and more physicians to consider referring their pain patients for psychological care.
In a symposium titled Pain Psychology 101, hosted by the American Pain Society (APS) today at its annual scientific conference, leading pain psychologists presented compelling clinical evidence showing that cognitive therapies are safer and often more effective than opioids in fostering chronic pain relief.
“A great deal of evidence supports the efficacy of various cognitive-behavioral interventions for reducing pain intensity and improving psychological and physical functioning,” said Mark Jensen PhD, symposium speaker and a clinical psychologist at the University of Washington. “They help patients let go of the struggle against pain and move toward achieving their most valued life goals.”
Jensen added that studies show the average pain reduction achieved with opioids is just 32 percent, and these drugs have numerous side effects. But there is evidence that opioids and other analgesic medications are more effective if depression, anxiety and other mental health symptoms are addressed.
“People with the highest levels of psychological distress and fear get the least benefit from opioids and tend to experience more side effects,” said panelist Robert Edwards PhD, clinical psychologist at Brigham and Women’s Hospital. “Cognitive-behavioral therapy, therefore, when employed in tandem with drug treatment, is a proven approach for achieving better outcomes.”
David Williams PhD, incoming APS president and University of Michigan psychologist, believes psychological care will become a more frequent treatment option for chronic pain, based on recommendations in the federal government’s National Pain Strategy.
“With its strong advocacy of multidisciplinary pain management, the National Pain Strategy recognizes what psychologists have known for decades – chronic pain is a complex bio-psycho-social condition requiring multi-modal approaches, including various psychological interventions, to improve overall function and quality of life,” said Williams. “Now the challenge is to convince primary-care doctors they can refer patients for cognitive-behavioral therapy and not be fearful of alienating or stigmatizing a patient.”
Judith Paice RN PhD works with cancer pain patients at Northwestern Memorial Hospital in Chicago and spoke as the only non-psychologist on the symposium panel. “It can be difficult for a non-psychologist to determine if someone with chronic pain would benefit from cognitive-behavioral therapy,” said Paice. “You should be prepared for negative reactions from patients and help them overcome stigma associated with seeing a psychologist.”
Paice added there are cues physicians might observe that may indicate which patients should be referred to a psychologist. “People who start crying in the first minute or two or show overt symptoms of depression or anxiety should be referred to a psychologist,” she said. “Also, how the patient answers a simple question like ‘what are your goals’ can provide a strong cue. If the answer is ‘I want to get my life back’ or something like that, a psych referral is in that patient’s best interest.”
Psychotherapies for pain management include Cognitive-Behavioral Therapy, Acceptance and Commitment Therapy, relaxation training, pain coping skills training, muscle relaxation and self-hypnosis training.
About the American Pain Society
Based in Chicago, the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.