The U.S. Food and Drug Administration says immediate-release opioid pain medications will have to carry a warning label about the serious risks of misuse, abuse, addiction, overdose and death.
Last week, the U.S. Centers for Disease Control warned doctors about overprescribing narcotic painkillers because it too often leads to drug addiction and overdose deaths. The CDC described addiction to prescription opioid drugs as an epidemic.
Dr. Robert Califf, the FDA commissioner, was quoted in a news release as saying the “actions are one of the largest undertakings for informing prescribers of risks across opioid products, and one of many steps the FDA intends to take this year as part of our comprehensive action plan to reverse this epidemic.”
U.S. health agencies are encouraging doctors and patients to explore alternative ways to reduce pain. A new study shows that mindful meditation and cognitive behavioral therapy can work better and the results can last longer than standard care for chronic back pain.
One author of the study said he would expect it to help people who suffer from other types of chronic pain as well.
Daniel Cherkin, a senior investigator at the Group Health Research Institute in Seattle and lead author of the study, said: “One of the most important new understandings of chronic pain and chronic low back pain is that the mind plays a very important part.”
Three hundred forty-two people with chronic back pain participated in the study. Cherkin said a third of them participated in cognitive behavioral therapy (CBT), which "focuses on helping people learn how to change how they think about their pain and helps promote concrete activities that people can do to better manage it."
Meditation, yoga
Another third practiced mindfulness-based stress reduction (MBSR), which brings together elements of meditation and yoga. “Mindfulness tries to help people change their awareness, increase their awareness of their pain and to become more accepting of the pain, and then, to focus their energies on finding ways to constructively manage it,” Chirken said.
The rest followed the usual care recommended by their primary doctors, which could include such things as medications to reduce pain, exercise and massage therapy.
Participants in the mind-body groups received training and/or therapy, workbooks, CDs and instructions they could use at home. Halfway through the study, at 26 weeks, participants using mindfulness and CBT had greater improvement in function and back pain than the group that followed standard care. Results for the mind-body groups were similar: 43.6 percent improvement in the mindfulness group and 44.9 percent in the cognitive therapy group, compared with 26.6 percent in the standard care group.
Difference in results
The study continued for a year. At 52 weeks, those using mindfulness-based stress reduction continued to see improvement, while those in the cognitive behavioral therapy group did not see improvement beyond 26 weeks. The researchers concluded that mindfulness may be an effective treatment for chronic low back pain.
“Benefits in decreased pain and improved function lasted for a full year, which is not common among most treatments for chronic pain,” Cherkin said.
Benjamin Balderson, a psychologist and co-author of the study, said, “We teach things such as how to manage the emotional impact of pain, how to manage the activity impact of pain, how to manage the things that sometimes are not addressed in primary care or in usual care for chronic pain. So, by doing that we look at a more holistic level of approach.”
The study was published in the Journal of the American Medical Association. It was funded by the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health.
Other types of pain
In a news release, Josephine Briggs, director of NCCIH, was quoted as saying, “It is vital that we identify effective non-pharmacological treatment options for 25 million people who suffer from daily pain in the United States. The results from this research affirm that non-drug/non-opioid therapies, such as meditation, can help manage chronic low back pain. Physicians and their patients can use this information to inform treatment decisions.”
Although the research focused on back pain, Cherkin told VOA, "CBT has already been found effective for other types of pain," and while "MBSR hasn't been studied much for other pain ... I would expect it would be helpful for a variety of chronic conditions because it is not specifically focused on back pain or other specific conditions."
