Behavioral Therapy Effective Alternative to Opioids for Chronic Pain

Nondrug approaches to pain management may help fight the opioid epidemic.

While opioids have been commonly prescribed to treat pain, physicians and policymakers are revisiting prescribing policies due to the surge of deaths related to the opioid epidemic. Health experts have called for alternative therapies for patients experiencing pain, including yoga or acupuncture.

Teaching patients different ways to deal with chronic pain may be an effective alternative approach to drive down unnecessary opioid prescriptions, according to a study published by the Journal of Psychiatric Practice.

Prescribing opioids to treat chronic pain has been a significant contributor to the opioid epidemic. Despite the increase in prescriptions, Americans are not reporting lower levels of pain, while other research has called into question whether or not opioids effectively treat chronic pain.

“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," the authors wrote.

In the new study, the authors discuss data that suggests cognitive behavioral therapy (CBT) could be used as an alternative therapy to opioids for chronic pain.

"Cognitive behavioral therapy is a useful and empirically based method of treatment for pain disorders that can decrease reliance on the excessive use of opiates," the authors wrote.

The goal of CBT is to change the way patients perceive and manage pain by teaching them that it can be controlled. CBT helps patients view pain as a stressor that they can cope with, according to the authors.

The authors said that patients may learn interventions, including relaxation, participating in pleasant activities, cognitive restructuring, and exercise, according to the study. Previous studies have shown that these interventions could improve pain and quality of life.

"Therapy helps the patient see that emotional and psychological factors influence perception of pain and behaviors that are associated with having pain," the authors wrote. "Therapy...puts in place cognitive and behavioral strategies to help patients cope more successfully."

The authors note that recent studies show CBT and alternative therapies are effective for chronic pain. These findings report that CBT may normalize gray matter in the brain, which is thought to shrink due to chronic stress, according to the study.

CBT has also demonstrated the ability to lower pain without risking opioid addiction and overdose. It can be used with or without drug therapy to reduce pain levels and may be especially beneficial for patients at a high risk of opioid misuse disorder.

However, nondrug therapy is underused due to a lack of knowledge, time pressure, patient concerns, and low reimbursement, according to the study.

The authors said there is a need for resources dedicated to training physicians and integrating CBT into pain treatment guidelines, according to the study.

"There is a need for a paradigm shift from a biomedical to a biopsychosocial model for effective pain treatment and prevention of opioid use disorder," the authors concluded. "Increased use of CBT as an alternative to opioids may help to ease the clinical, financial, and social burden of pain disorders on society."