Chronic pain is considered the most common reason of seeking medical help. According to Tompkins, Hobelmann, and Compton (2017), about 100 million adult Americans suffer from this condition. Gaskin and Richard (as cited in Tompkins, Hobelmann, & Compton, 2017) claim that total expenses on treating chronic pain constitute up to $635 billion annually. For now, most of chronic pain patients are offered opioid therapy, which is associated with several disadvantages, including opioid dependence.Regarding substantial costs and a vast number of patients, medical community is constantly evaluating effectiveness of traditional interventions and seeks new strategies of treatment.
This literature review analyzes three scholarly articles, which were issued in 2017. All of them cover topic of chronic pain treatment. Analyzed articles proclaim the necessity to minimize the use of opioids and instead suggest relying more on non-pharmacological interventions.
The article “Providing Chronic Pain Management in the “Fifth Vital Sign” Era: Historical and Treatment Perspectives on a Modern-Day Medical Dilemma” was published in Drug and Alcohol Dependence. It provides a narrative review on scientific perception of chronic pain and harms and benefits of opioid and non-opioid interventions. At the beginning, the authors describe general definition of chronic pain and its biological mechanisms, providing the reader with a background, needed to understand following information (Tompkins et al., 2017). This feature facilitates the comprehension of the article; however, it is doubtful that intended academic audience needs such explanations. The article focuses on the history of the multidisciplinary approach of chronic pain treatment and marks common overreliance on opioids as a negative sign, stating disadvantages of this therapy (Tompkins et al., 2017). The authors analyze studies of effectiveness of non-opioid interventions, including antidepressants, physical therapy, psychotherapy, complementary medicine, and invasive methods. In conclusion, they state that all available interventions have advantages as well as disadvantages, but there is insufficient amount of data on their long-term effects. In addition, due to peculiarities of the health care system many patients may have limited access to non-opioid or multidisciplinary treatment (Tompkins et al., 2017).
Since this article is a review, it may be suspected in biased choice of analyzed publications. In addition, the authors claim the novelty of this scientific field, which may have resulted in insufficient amount of data to analyze. Future studies may find new evidence, which contradict conclusions of this article. Given article is simply a review of available data; it may quickly lose its relevance.
Another article, “Pain, Hedonic Regulation, and Opioid Misuse: Modulation of Momentary Experience by Mindfulness-Oriented Recovery Enhancement in Opioid-Treated Chronic Pain Patients,” also was published in Drug and Alcohol Dependence. The authors state that long-term opioid therapy may lead to misuse and suggest non-pharmacological interventions instead. In this study, they were using data from ecological momentary assessments (EMA) to determine effects of a Mindfulness-Oriented Recovery Enhancement (MORE) intervention (Garland et al., 2017). Another purpose of this study was to find correlations between opioid misuse at post-treatment and changes in pain level. The study used unpublished data from the previously conducted randomized controlled trial. It had 55 participants (21 males, 34 females), previously diagnosed with chronic pain and reported to use opioid medications nearly every day. All of them had symptoms of the opioid dependence. During eight weeks, they were attending MORE sessions. The control condition was a support group for chronic pain patients, prescribed with opioids. Every day, participants were completing EMA, evaluating their pain intercity and affective state. The results have shown that, comparing to control group, MORE group had lower levels of momentary pain, had better affect regulation and improvements in positive affect. The authors claim that MORE intervention may decrease pain, psychological suffering, and risk of opioid misuse among chronic pain patients (Garland et al., 2017).
The authors admit their study has several limitations, including a small homogenous sample and lack of information about doses of opioid medications, taken by participants (Garland et al., 2017). Nevertheless, this study has confirmed positive results of non-pharmacological intervention which may encourage other scientists to continue experiments.
The third article, “Evaluation of a Psychological Intervention for Patients with Chronic Pain in Primary Care,” evaluates impact of multicomponent cognitive-behavioral therapy on treating Spanish chronic pain patients from lower social classes. The sample consisted of 40 people from Utrera, Spain. During 10 weeks, they were attending weekly sessions. To analyze data, the authors used statistics and instruments, recommended by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT). According to the authors, all patients reported about improvement; however, at the follow-up after six months, two of them claimed their improvement had disappeared (Cano-García, González-Ortega, Sanduvete-Chaves, Chacón-Moscoso,& Moreno-Borrego, 2017).
Although the results have confirmed the positive impact of multicomponent cognitive-behavioral therapy, its design has some limitations. First of all, sample of forty people is not big enough to get relevant results. Second, there was no control group to compare results. The authors claimed they could not establish it due to ethical reasons (Cano-García et al., 2017).
This literature review has examined three articles about treatment of chronic pain. All of them mentioned disadvantages of opioid interventions and suggested non-opioid or non-pharmacological treatment. However, studies, that confirmed efficiency of non-opioid approach, have limitations which may have affected their relevance. Authors may be restricted because of insufficient funding or ethical reasons. Nevertheless, their findings prove this is possible to benefit from use of multidisciplinary approach in treating chronic pain.
- Cano-García, F. J., González-Ortega, M. D., Sanduvete-Chaves, S., Chacón-Moscoso, S., & Moreno-Borrego, R. (2017). Evaluation of a psychological intervention for patients with chronic pain in primary care. Frontiers in Psychology, 8, 1-12. Retrieved from doi:10.3389/fpsyg.2017.00435.
- Garland, E. L., Bryan, C. J., Finan, P. H., Thomas, E. A., Priddy, S. E., Riquino, M. R., & Howard, M. O. (2017). Pain, hedonic regulation, and opioid misuse: Modulation of momentary experience by Mindfulness-Oriented Recovery Enhancement in opioid-treated chronic pain patients. Drug and Alcohol Dependence, 173, 65-72. Retrieved from doi:10.1016/j.drugalcdep.2016.07.033.
- Tompkins, D. A., Hobelmann, J. G., & Compton, P. (2017). Providing chronic pain management in the “Fifth Vital Sign” Era: Historical and treatment perspectives on a modern-day medical dilemma. Drug and Alcohol Dependence, 173, 11-21. Retrieved from doi:10.1016/j.drugalcdep.2016.12.002.