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Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
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The Future of Chronic Pain Treatment Could Be Online, Not On Meds
Treatment of chronic pain requires an approach that includes psychological intervention for success. A recent report suggests that non-pharmacologic therapies may be at least as effective as medications in treating chronic pain, and the Internet may prove to be a valuable method for delivering these interventions. Before you shake your head that this can’t be true, read on.
Medications alone are of only modest benefit and rarely lead to clinically meaningful functional improvement among patients with chronic pain. There is strong evidence, however, for non-pharmacologic therapies such as cognitive-behavioral therapy in improving functional status and mood, as well as pain itself.
Yes, we are talking about cognitive-behavioral therapy again. An analysis of 25 papers found that psychological treatments with cognitive-behavioral therapy (CBT) resulted in greater improvements in pain experience, coping, and behavioral expressions of pain, compared to other active treatments.
The sad truth is that the use of non-pharmacologic treatment has been limited for a variety of reasons: medical schools don’t spend much time teaching it, insurance companies don’t adequately cover it, patients don’t have easy access to it, and it lacks the marketing that pharmaceutical companies devote to their drugs.
Can we solve those issues by delivering these interventions via the internet? Cost, access and convenience are obviously better. If so, what Web-based interventions work?
Dr O.
Medications alone are of only modest benefit and rarely lead to clinically meaningful functional improvement among patients with chronic pain. There is strong evidence, however, for non-pharmacologic therapies such as cognitive-behavioral therapy in improving functional status and mood, as well as pain itself.
Yes, we are talking about cognitive-behavioral therapy again. An analysis of 25 papers found that psychological treatments with cognitive-behavioral therapy (CBT) resulted in greater improvements in pain experience, coping, and behavioral expressions of pain, compared to other active treatments.
• In patients with chronic low back pain psychological interventions – particularly CBT – have been shown to reduce pain intensity and depression while improving quality of life.For 30 years the effectiveness of non-pharmacologic therapy in those with chronic pain rivals and even surpasses some pharmacologic approaches, yet non-pharmacologic interventions are rarely used in clinical practice.
• In fibromyalgia patients non-pharmacologic therapies had a greater effect than medications for fibro pain.
The sad truth is that the use of non-pharmacologic treatment has been limited for a variety of reasons: medical schools don’t spend much time teaching it, insurance companies don’t adequately cover it, patients don’t have easy access to it, and it lacks the marketing that pharmaceutical companies devote to their drugs.
Can we solve those issues by delivering these interventions via the internet? Cost, access and convenience are obviously better. If so, what Web-based interventions work?
• E-mail discussion groups have shown good results in studies. In people with chronic low back pain a moderated e-mail discussion group combined with a workbook and videotape about back pain resulted in significant improvements in pain, disability, and distress after 1 year.Clearly, we need to expand our Internet-based resources for the treatment for pain. It is interesting and too hard to ignore that pursuing non-pharmacologic treatment may be one of our best tools against chronic pain.
• A study of 56 patients with chronic low back pain who were given 8 weeks of either Internet-based CBT with telephone support or nothing showed at 3 months those who had treatment showed significant improvements in control over pain, and ability to decrease pain.
• PainAction. This web site for people with chronic back pain was based on CBT and self-management principles, including goal setting, problem solving, relapse prevention, nutrition, stress management, and exercise. At 6 months, significant changes were seen in pain, depression, and anxiety.
Dr O.
RELATED POSTS
I need help. I have had pain for 8.5 years. I have had an extreme flare up since November 2007. I have lost my ability to function- I cannot do the dishes, tolerate a hair cut, or even stay out of bed for more than 6 hours (absolute max) at a time.
Posted on 02/24/08 10:26:36 am
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The real downside is that I have seen a situation time and again where Dr's will tell female patients that the pain is all in their heads and it freaking drive's me nuts to think that that is considered sound medical advice and that being directed to a psychologist is the only remedy offered.
I am one of the lucky ones out there where surgical intervention finally resolved my pain issues. Thankfully I have a great surgeon and medical team that believes me (for the most part). The surgery they did was supposedly something that should not have done anything to help and yet I feel so much better.
I have tried the power of the human brain and yes, it can be trained to ignore pain to a certain extent as with the intervention of TENS machines or hot and cold treatment to trick the brain of think of something else other than pain, for a period of time...
Another form of pain relief I've tried is meditation as with a good coach the more deep in meditation you can achieve, the easier the pain is to live with... The big problem we all face is almost all these ways to relieve pain are temporary and we have to return to a way of coping as best we can...
If we could just mix Eastern meditation with Western medicine we may find some sort of relief from this awful chronic pain...!
There are lots of support groups out there so make sure you join one that is sincere about 'connecting' and becoming a 'group', in all meanings of the word.
I would also like to extend an invitation to Dr. Orange to be a guest on my radio program to discuss this very topic. I do a weekly program called: "Winning Life Through Pain". We, (my co-host and I), have been doing this show for 4 years and have had many guests on many topics. And it would be an honor to have you as a guest as well.
Looking forward to hearing from you soon to get you on the schedule of shows to come. =)
~Blessings!~
RSD Coach Marla
i have chronic pain (RSD) and have found that many people who don't understand it, don't want to hear it. doctors often dismiss chronic pain patients as drug seekers or jumpers, so maybe it's that people can freely express their emotions and physical feelings with others who truly understand.