The new guidelines for prescribing opioids released by the Centers for Disease Control and Prevention (CDC) have given way to other behavioral management therapies to manage stress such as Cognitive Behavioral Therapy (CBT). Mindfulness based stress reduction (MBSR) is advised and recommended by CDC and has proven to be effective.
Two large, randomized trials have been conducted, both showing that mindfulness meditation can help with improving chronic lower back pain. The first study involved 324 adults with lower chronic back pain who were divided into three groups. The first group was involved in an 8-week program that had two hour long MBSR sessions, including meditation and yoga. The second group was also part of an 8-week program but with two hour long CBT training sessions, which helped participants learn how to change their thoughts about pain. The third group was a usual care group. The results showed that the CBT group had the highest pain reduction as opposed to the rest of the groups.
In another study, 282 adults underwent mindfulness meditation sessions lasting 8 weeks, followed by six monthly sessions. Results showed that participants experienced a decrease in their symptoms of up till 30% as compared to the control group, who only felt a change of 25.2%.
In a study published in the Journal of Neuroscience researchers also studied the neural circuits of how the brain works in order to reduce pain through mindfulness. Volunteers were provided with a task and divided into two groups, one receiving mindfulness meditation in the presence of a noxious stimuli and the other was the control group. The volunteers’ brain activity was recorded and studied through functional magnetic resonance imaging. They found that the mindfulness group felt lesser pain of up to 57% as compared to the control group, which also reported less pain but only up to 40%. Furthermore, the results of the MRI revealed that the orbitofrontal cortex (OFC) was stimulated during meditation and this contributed to the reduction of pain.
Zeidan, the lead author of the study and associate director of neuroscience at Wake Forest University’s Center for Integrative Medicine, adds, ‘Mindfulness meditation deactivated the thalamus, which serves as a gateway between the spinal cord and the brain, and was associated with reduced pain unpleasantness.’
Most CBT therapy sessions usually stretch over to 8-24 sessions to control pain with ‘booster’ sessions in between to refresh the skills taught to the clients.
However, there are people who are not in favor of CBT. They argue against its effectiveness and refuse to acknowledge the benefits it might hold. A chartered psychologist, Mr James, at the Limbus Critical Psychotherapy Conference, claims that the only reason CBT appeals to politicians and the National Institute for Health Care and Excellence (NICE) is because it is quick and cheap. Others have argued that it does not address the underlying core issues. Thus, it is deemed ineffective since it only takes into account issues at a surface level and not a long term treatment plan. Moreover, mindfulness based meditation primarily teaches a person to be more aware of his or her thoughts and physical sensations, such as breathing in his current present surroundings and to view them without any judgment. This can only be achieved when there is a good rapport present between the therapist and the client. Results of this sort of treatment depend heavily on the relationship built between these two and thus are a little risky. Sometimes, the negative thoughts that a person is asked to talk about or the unpleasant feelings associated with their pain can induce harmful effects, such as increasing the vulnerability of the patients and making them feel worse. This is particularly true in the case of those who have experienced trauma, as they tend to relive the entire event.
Nonetheless, literature from previous researches shows how CBT has been involved in reducing chronic pain. In a study by Nicholas et al (2013) outpatients were given a pain self-management program involving CBT and exercises for older adults (above the age of 65). Results showed that 44% of the pain management programs showed significant improvement one month after treatment as compared to other groups.
These results give way to non-pharmacologic and mind body therapies being applied for chronic pain treatment and shifting the attention from a ‘biomedical disease model’ to a ‘patient centered model’. Hospitals and clinics need to take notice and include these therapies as part of their treatment programs.
CDC hopes that the guidelines imposed on prescribing narcotics will do just that and change clinical practice and spread knowledge of how harmful opioids can be. Together patients and physicians can come up with other alternative methods, develop new therapies and combine the already existing approaches to eventually improve health care for all.