Results from a systematic review and meta-analysis published in JAMA Internal Medicine suggest that mind-body therapies (MBTs) may reduce pain symptoms in adults prescribed opioids for clinical pain. MBTs were also linked with small declines in opioid dose, a promising finding in light of concerns surrounding the scale of opioid prescriptions in the United States.
Eric L Garland, PhD, from the Center on Mindfulness and Integrative Health Intervention Development at the University of Utah in Salt Lake City, searched the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases from inception through March 2018 for randomized clinical trials and systematic reviews of MBTs for pain management. Investigators extracted study data and assessed the risk for bias. Outcomes of interest were pain intensity, opioid dose, opioid misuse, opioid craving, disability, and function. Mixed-effects meta-analyses were performed to assess the impact of MBTs on pain- and opioid-related outcomes.
A total of 60 articles comprising 6404 participants were included in the analyses. Studies tested a wide range of MBT modalities, including meditation (n=5), hypnosis (n=25), relaxation (n=14), guided imagery (n=7), therapeutic suggestion (n=6), and cognitive behavioral therapy (CBT) (n=7). The majority of studies sampled (n=39) focused on procedural pain.
In the overall meta-analyses, MBTs had a significant, moderate association with reduced pain (Cohen d = -0.51; P <.001) and a significant, small association with reduced opioid use (Cohen d = -0.26; P =.01). The risk for bias was generally low.
Moderate to large effect sizes in pain improvement were observed with meditation (Cohen d = -0.70; P <.001), hypnosis (Cohen d = -0.54; P <.001), suggestion (Cohen d = -0.68; P =.008), and CBT (Cohen d = -0.43; P =.002). Improvements in opioid-related outcomes were also observed in the majority of meditation (n=4; 80%), hypnosis (n=12; 63%), and CBT (n=4; 57%) studies. In studies of suggestion, guided imagery, and relaxation, however, opioid-related improvements were less often observed.
In light of these findings, MBTs may have utility in reducing opioid-related problems, such as cravings and misuse.
As study limitations, investigators noted the heterogeneity in methods across studies; some assessed post-intervention acute pain, while others captured pain over 3 months or longer. In addition, some studies with small sample sizes may have been underpowered.
“Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes,” the investigators wrote.
Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures
Garland EL, Brintz CE, Hanley AW, et al. Mind-body therapies for opioid-treated pain: a systematic review and meta-analysis [published online November 4, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.4917