17 Feb Using CBT and Other Alternatives Instead of Opioids for Chronic Pain

With opioid addiction reaching critical levels, finding alternative options for pain management is vital. It’s time for medical practitioners to start investigating other forms of treatment for pain and minor mental health issues. According to Medical News Today, more and more studies have shown that cognitive-behavioral therapy (CBT) can help people cope with chronic pain.

So, why aren’t more health professionals offering this alternative to patients? The problem may lie in the lack of adequate pain management training available to behavioral health physicians. CBT and other non-pharmacological treatments are not being used for a variety of reasons. The most common reason is unfamiliarity, but there’s also time-pressure, patient demands for convenience, and it’s easier to prescribe medication. Many physicians are also aware that the use of opioids does little to change the severity of pain experienced by patients. Therefore, the opioid crisis can be diminished through the widespread implementation of CBT and other alternatives.

A Dangerous Cycle

The issue with opioids that are generally prescribed to treat pain, is that prolonged use sometimes ends up with the pain-relieving effects being diminished as the body builds up a tolerance. Subsequently, people will feel the need to increase their dosage to relieve the pain which leads to dependency. Opioid dependence causes withdrawal symptoms to occur, which makes it difficult to stop taking them. Addiction happens when this dependence on the medication interferes with daily life. This is an all too common scenario for many individuals who are prescribed strong opiates for their chronic pain.

The Potential of CBT

Many studies, such as Cognitive-Behavioral Therapy for Patients with Chronic Pain, conducted by researchers for Wolter Kluwers Health, indicate that CBT improves pain management and related problems regardless of whether it is administered alone or in conjunction with medication. When used in combination with other alternative approaches such as hypnotherapy, mindfulness-based stress reduction (MBSR), or meditation, the results are even more effective.

For a long time, CBT has been used in the treatment of major mental health disorders such as depression, bipolar disorder, and anxiety. However, the use of such treatment for chronic pain and mild mental illnesses is a relatively recent development. Nevertheless, this development gives therapists cause for hope that something can be done about the prevailing opioid crisis.

Dr. Muhammad Hassan Majeed of Natchaug Hospital, and Dr. Donna M. Sudak, from Drexel University College of Medicine, note that CBT is useful because it is an empirically based method of treatment for chronic pain. This approach can decrease patients’ reliance on opiates and prevent excessive use thereof. In their discussion of the evidence relating to CBT as an alternative technique to manage chronic pain, they conclude: “There is no evidence that supports the use of opioids for the treatment of chronic pain for more than one year, and chronic use increases the serious risks of misuse, abuse, addiction, overdose, and death.”

As a result, both believe that CBT is the ideal alternative to opioids and has great potential for chronic pain management. The main aim of CBT is to change patterns of thinking or behavior which allows patients to shift their perspective on pain and how they choose to manage it. It’s not to say that pain “is all in your head”, but rather that pain can also be managed by a change in the state of mind. This is where CBT can help patients understand that pain is a stressor and that through adaptation, they can learn to cope with it. It’s through this therapeutic process that people discover that emotional and psychological factors affect their perception of pain, and they’re able to change their perception.

Pain Management Treatment Options

Treatment plans may include relaxation training, making time for pleasure activities such as hobbies, restructuring one’s mind, low-impact or gentle exercise, and meditation. This should be facilitated by an empathetic and validating therapist. These interventions “have the potential to relieve pain intensity, improve the quality of life, and improve physical and emotional function,” according to Majeed and Sudak.

Therapists could begin by educating patients about their diagnosis and about CBT, set goals, and teach essential thinking and behavioral skills. When working with patients with chronic pain, they may put special emphasis on identifying and modifying maladaptive behaviors that have a role in maintaining pain and work on identifying and increasing adaptive behaviors.

Moving forward, behavioral health professionals should receive adequate pain management alternatives training in order to provide safe and effective outcomes-based care. The use of CBT in treating chronic pain still needs a lot more research and attention. All dimensions of treatment possibilities and intersections are important in future studies. What we know now, is that it works in the broadest cases, and with refinement, might be able to help many types of chronic pain and mental health disorders.