brand logo

Am Fam Physician. 2020;102(2):119

Clinical Question

Are mind-body therapies, including meditation, hypnosis, and relaxation, effective for decreasing pain or affecting opioid use in patients with acute or chronic pain?

Bottom Line

Using mindfulness, meditation, hypnosis, therapeutic suggestion, and cognitive behavior therapy, in addition to opioid treatment of acute or chronic pain, provides an additional benefit to patients by reducing pain scores. Some of these interventions will decrease the duration or amount of opioid needed. (Level of Evidence = 1a)

Synopsis

To assemble randomized controlled trials to combine for this meta-analysis, the researchers searched six databases, including the Cochrane Library, for English-language articles on mind-body therapies. They also searched bibliographies of retrieved articles and the websites of the Agency for Health Care Quality and Research, American Psychological Association, and the World Health Organization. Two authors independently selected studies for inclusion, extracted the data, and assessed the risk of bias. They identified 60 studies of 6,404 participants that evaluated mind-body approaches on procedural pain, burn pain, cancer pain, and chronic pain. Most studies were at low risk of bias because of their designs. Pain intensity was reduced by a moderate to large amount with meditation (mindfulness), hypnosis, therapeutic suggestion (suggestions to change thoughts, emotions, or sensations without inducing hypnosis), and cognitive behavior therapy. Meditation, cognitive behavior therapy, and hypnosis also decreased opioid-related outcomes such as opioid misuse, opioid craving, and time to opioid cessation (acute pain). There was a high degree of heterogeneity among the studies regarding the size of the effect. Studies that did not show benefit of meditation and therapeutic suggestion may not have been published (i.e., publication bias may have occurred, amplifying the actual benefit of these approaches).

Study design: Meta-analysis (randomized controlled trials)

Funding source: Government

Setting: Various (meta-analysis)

Reference:GarlandELBrintzCEHanleyAWet alMind-body therapies for opioid-treated pain: a systematic review and meta-analysis. JAMA Intern Med2020;180(1):91–105.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

Continue Reading


More in AFP

More in Pubmed

Copyright © 2020 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.