Mind-body therapies linked to decrease in pain, opioid use

  • JAMA Intern Med

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • The use of mind-body therapies (MBTs) was associated with a moderate decrease in pain and a slight decrease in opioid use, and may help with opioid craving and misuse.
  • The largest effect was found with meditation, hypnosis, suggestion, and cognitive behavioral therapy (CBT).

Why this matters

  • This meta-analysis is the largest study to date of the use of MBTs to treat pain and their effect on opioid use.

Study design

  • Systematic review/meta-analysis of 60 randomized clinical trials (opioid-treated pain; n=6404).
  • Interventions: meditation (5 studies), hypnosis (25 studies), relaxation (14 studies), guided imagery (7 studies), therapeutic suggestion (6 studies), and CBT (7 studies).
  • Funding: None disclosed.

Key results

  • Overall, MBTs were associated with a reduction in:
    • pain (moderate association; Cohen's d, −0.51; P<.001 and>
    • opioid dose (small association; Cohen's d, −0.26; P=.01).
  • Significant improvements in pain outcomes were noted for:
    • meditation (strong association; Cohen's d, −0.70; P<.001>
    • hypnosis (moderate association; Cohen's d, −0.54; P<.001 and>
    • suggestion (moderate association; Cohen's d, −0.68; P=.008).
  • Improved opioid-related outcomes were reported with meditation (4 studies), CBT (4 studies), and hypnosis (12 studies).

Limitations

  • The study may have been underpowered.
  • High levels of heterogeneity.

Coauthored with Chitra Ravi, MPharm