In light of increasing concerns about a reliance on pharmacotherapy for chronic noncancer pain conditions, there has been renewed emphasis on integrative — multidisciplinary and multimodal — pain management approaches focusing on biopsychosocial models. A pair of recently-reported observational studies examined outcomes of integrative pain management programs, finding that they are not beneficial for all patients and are highly dependent on patient characteristics and treatment components.
Study A: Multidisciplinary Treatment of Chronic Widespread Pain (CWP)
Research exploring the effectiveness of multidisciplinary approaches for the treatment of chronic widespread pain (CWP) has been limited, largely due to considerable heterogeneity among patients. Therefore, a research team from Amsterdam, The Netherlands, headed by Aleid de Rooij conducted an observational trial to identify predictors of integrative treatment outcomes in patients with CWP [de Rooij et al. 2013]
Up to half of all persons can expect to experience at least some neck pain in their lifetime. Pharmacotherapy for neck pain is generally only palliative in nature and evidence for the effectiveness of nondrug therapies has been limited. Therefore, neck pain has become a major health burden in most societies worldwide. Three recent studies report on the efficacy of nondrug approaches for managing several types of neck pain, finding favorable outcomes of yoga and fear-avoidance training, while disparaging spinal manipulative therapy.
Considerable excitement was recently generated by newly-reported research finding that a significant percentage of patients with chronic lower-back pain could be helped by a 100-day course of antibiotic therapy. While this was hailed as a major medical breakthrough, potentially sparing millions of patients from suffering and major back surgery, some caution seems warranted until this approach is more adequately tested and validated.
As a form of complementary and alternative medicine (CAM), reflexology has gained popularity in the treatment of various conditions, including those relating to pain. Foot reflexology in particular, as a special type of massage therapy applying principles of Traditional Chinese Medicine, has generated much interest, and a newly reported study examined its effects on pain threshold and tolerance. Although outcomes were reportedly favorable, this and other research on foot reflexology does not appear to provide convincing evidence that it is an effective and durable treatment for any type of pain-related condition. Could this be an example of “Fairy Tale Science”?
Featured Items: lubiprostone (Amitiza) approved for treating opioid-induced constipation; controlled-release oxycodone HCl (OxyContin) abuse-deterrent labeling approved; generic versions of Suboxone (buprenorphine/naloxone) receive FDA approvals. — All brand names are trademarks of their respective manufacturers. Compiled by Winnie Dawson, MA, RN, BSN.
Ever since last summer, 2012, when Physicians for Responsible Opioid Prescribing (PROP) submitted their petition to the U.S. Food and Drug Administration (FDA) requesting changes to the labeling of opioid analgesic products, there has been a passionate debate raging among those favoring and those opposing the changes. Most professionals seem to believe such actions have no valid scientific justification and would ultimately increase patient suffering — including, most recently, the American Medical Association (AMA).
There has been much concern about the safety of long-term opioid analgesics, with some studies reporting unexpectedly high rates of overdoses and deaths as doses are increased. Now, however, preliminary data suggest a contrary perspective in the ongoing debate; that is, higher-dose opioid prescribing may not be a primary influence on overdose.
Mindfulness-based interventions (MBIs) emphasizing nonjudgmental attitudes toward present-moment experiences have been widely used to help patients with chronic pain. Although changing or controlling pain is not always an explicit aim of MBIs, a recently reported review of research studies suggests that mindfulness practices may lead to favorable changes in pain tolerance and intensity ratings. However, the evidence in this regard seems neither robust nor highly convincing.
As previous UPDATES articles warned, there has been a growing resurgence of “smack” (ie, heroin) raging across the United States, due largely to restrictions on pain reliever prescribing and abuse-deterrent formulations of those drugs. According to a recent report in USA Today, heroin is spreading like a cancer into even the most upscale suburban areas throughout the country.
A new national public opinion poll finds that Americans appear to be more concerned about pain-reliever abuse and addiction than chronic pain itself. In fact, slightly more than half of respondents think that healthcare providers should have set limits on the amount of pain medication they can prescribe. Yet, there are many contradictory and confusing aspects of this poll that need careful consideration.






