Cognitive-behavioral therapy modestly reduces chronic pain in patients taking opioids


November 02, 2021

2 minutes to read

Source / Disclosures

Disclosures: DeBar reports receiving a grant from NIH. Please see the study for relevant financial information from all other authors.

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Patients with chronic pain receiving long-term opioid therapy who were assigned cognitive behavioral therapy reported reductions in pain and pain-related disabilities, the data showed.

However, the use of opioids by patients has not decreased, according to the results of a randomized controlled trial published in Annals of Internal Medicine.

DeBar L, et al. Ann Med Intern. 2021; doi: 10.7326 / M21-1436.

“Opioids have always been touted as a long-term management solution, despite the lack of rigorous evidence. This approach has created a host of adverse effects for patients and society. Therefore, viable non-opioid options for the long-term management of chronic pain in primary care are needed ”, lynn To prohibit, PhD, MPH, a senior researcher at the Kaiser Permanente Washington Health Research Institute, and colleagues have written.

Patients on long-term opioid therapy may benefit from behavioral therapy “that does not carry the corresponding risks that more biomedical therapy may have,” DeBar told Healio Primary Care.

Lynn DeBar

Researchers randomly assigned 850 adult patients on long-term opioid therapy for chronic pain to receive usual care (n = 417) or cognitive behavioral therapy (CBT) intervention (n = 433). Overall, the mean age of the patients was 60.3 years; 67.4% were female and 76.6% were white.

A behaviorist, nurse, physiotherapist, and pharmacist jointly taught pain self-management skills to patients in the intervention cohort during 12 weekly 90-minute group sessions. Sessions were yoga-based and incorporated relaxation techniques, activity and rest cycles, enjoyable activity programming, guided pictures and other distraction techniques, emotional regulation skills, cognitive restructuring , problem solving, and relapse prevention and maintenance, according to DeBar and colleagues. The intervention team met with primary care physicians to review admission summaries and assessments before and after group sessions.

The most common pain diagnoses among participants were limb or extremity pain, joint pain, and arthritis (81%); back and neck pain (74%); and general and diffuse pain (70%). The median daily opioid dose taken by participants was 29.6 milligram equivalents of morphine.

DeBar and colleagues found that patients in the intervention group experienced greater reductions in the impact of pain and pain-related disability compared to the usual care group. In addition, one in four patients receiving CBT experienced clinically significant reductions in pain (greater than 30%) compared to one in six patients receiving usual care.

Although opioid use did not decrease significantly, the researchers noted that patients taking benzodiazepines in the intervention group had greater reductions in use than patients in the usual care group.

Behavioral treatments like CBT can be effectively delivered in daily clinical care delivery systems, DeBar said.

“This study shows the potential of skills-based CBT interventions provided by front-line clinicians to reduce the impact of pain and improve function in patients with chronic pain receiving long-term opioid therapy,” reported writes DeBar and colleagues. “Although the effects were modest, they persisted after treatment until the last 12-month follow-up. “


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