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Science is Pushing for Non-Substance Therapies to Reduce Opioid Use

A meta-analysis examines treatments like meditation and cognitive behavioral therapy as alternatives for alleviating pain that is typically treated with opioids.

by Katie Way
Nov 4 2019, 4:00pm

Photo by iStock via Getty Images

The more we learn about opioids, the clearer it becomes that there’s no simple solution to the opioid crisis and the cycle of dependency and misuse that has already impacted millions of Americans. It’s especially difficult given how effective opioids are at pain management, particularly the kind of acute, short-term pain associated with cancer treatment, or surgical or injury recovery. Researchers are actively seeking alternatives to opioids when it comes to pain management—and a metastudy tracking the efficacy of mind-body therapies for treating pain that was previously managed with opioids indicates that some MBTs could act as effective pain management treatments, as well as tools for helping reduce opioid use and dependency.

The survey examined 60 studies looking at the effectiveness of “psychologically oriented MBTs,” including meditation, hypnosis, guided imagery, relaxation, cognitive behavioral therapy, and therapeutic suggestion, at pain management and/or opioid use outcomes. The overview found a moderately significant association between MBTs and pain reduction and a smaller significant association between MBTs and reduction of opioid doses, as well as some relationship between MBTs and the treatment of opioid misuse and cravings. Meditation was found to have the strongest correlation with both pain reduction: The five meditation-related studies reviewed all showed participants experiencing some level of pain relief from the therapeutic treatment. Four of the five studies also found meditation and mindfulness resulted in “opioid-related outcomes,” including decrease in opioid dosage, decreased cessation time, and dips in opioid misuse and cravings. Hypnosis and CBT were also associated with positive opioid-related outcomes, with 12 of 23 hypnosis studies and four of the seven CBT studies reviewed showing "significant therapeutic effects" on opioid use.

Eric Garland, the study’s lead author, said his background in social work led him to a better understanding of the relationship between MBTs and pain, as well as the one between MBTs and opioids. “I’m a licensed clinical social worker,” Garland told VICE. “I’ve used mind-body therapies both for the treatment of chronic pain as well as the treatment of addictive behaviors.” He said opioid misuse, pain, and MBTs all have one major factor in common: the brain. “Mind-body therapies make a lot of sense for the treatment of pain since all pain is in the brain. If you use a technique that changes the way the brain functions, that changes the way the brain interprets signals from the body and therefore it will affect the experience of pain, as well as the person’s emotional reaction to pain.”

Since long-term opioid use can lead to brain changes like opioid tolerance and a loss of the ability to self-regulate opioid usage, MBTs can play a dual role for someone already using prescription drugs to manage their pain, Garland said. “[MBTs] are all about teaching people a way to regain some of that control over the function of the brain and so therefore it can be useful not only for reducing the pain and helping the patient manage the pain, but also helping them gain better control over their opioid use itself.”

Does this mean people with opioid use disorder or who are living with pain from other medical procedures can ditch the Oxycontin and just fire up a Yoga with Adrienne video? Of course not. Research has shown that mindfulness and opioids don’t operate on the same parts of the brain, for starters, which means MBTs are a better side-by-side treatment than a ready-made substitute for medication. The 60 studies surveyed included a total of 6404 participants who were already taking opioids, which averages out to around 100 people per study—a sample group too small to base conclusive solutions on. And authors were careful to note that different MBTs were applied to different types of pain, with meditation studies tending to target chronic pain while hypnosis, relaxation, therapeutic suggestion and guided imagery treatments were more likely to be applied to acute pain. Garland also said in the future, he hopes more research will focus on the relationship between MBTs and opioid use, rather than just the relationship between MBTs and pain.

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Tagged:
Meditation
Opioids
pain management
Mind-body therapies
acute pain
opioid use disorder