Study Finds Viable Alternatives to Pain Management

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Study Finds Viable Alternatives to Pain Management    

Jim Windell

             According to research, it is estimated that about 19% of adults in the U.S. experience chronic pain. But when it comes to veterans, as many as 65% of veterans deal with regular pain. Often, people with chronic pain are only offered education in pain management or medication.

            A new study indicates that there are viable alternatives for pain relief.

            This study, published in the medical journal Pain, was conducted by the joint University of Washington Medicine and Veterans Affairs Puget Sound Health Care System. For the study, researchers tested the effects of two nonpharmaceutical pain interventions against an educational (control) protocol in a population of military veterans who received care from the VA between 2015 and 2020. Participants had experienced chronic pain not related to cancer for at least three months.

           At the study's outset, the 328 participants reported moderate or worse pain. Many also had depression, PTSD and sleep disturbance. They comprised a very diverse population for a clinical trial of pain treatments, according to lead author Rhonda Williams, University of Washington professor of rehabilitation medicine and  a clinician scientist at VA Puget Sound Health Care System.

           “We wanted to see which of the interventions led to the most improvement in pain intensity, pain interference, anxiety, depression, sleep, opioid medication use, and global perceptions of change,” said Dr. Williams. 

           The interventions used were mindfulness-focused meditation, hypnosis and education in pain management. All three interventions were associated with improvements, to varying degrees, across multiple outcome measures.

           By six months post-treatment, clinically meaningful improvements in pain intensity were reported by about 25% of people who had learned self-hypnosis, by about 22% of those who received training in mindfulness meditation, and only about 9% of those who received pain education. Participants in all three study cohorts experienced improvements in pain intensity, pain interference, and mood at the end of treatment, but the maintenance of benefits differed by treatment. Participation in mindful meditation resulted in greater decreases in average pain intensity and pain interference, relative to education. Participation in hypnosis resulted in greater decreases in average pain intensity, pain interference, and depressive symptoms at three and six months post-treatment, compared with the educational cohort.

           However, no significant differences between hypnosis and mindful meditation were seen in any outcome measures. Findings show that all three interventions provide post-treatment benefits over a range of outcomes, but the benefits of hypnosis and mindful meditation appeared more likely to persist, while the improvements associated with pain education seemed to dissipate over time.

           What surprised Williams was how enthusiastic the veterans were to receive the treatments, even after the study concluded.

           “While it’s normally hard to keep participants engaged in clinical research trials, this study had very high rates of retention,” Williams said. The VA is continuing to offer the test treatments and more than 200 veterans have pursued these outside of the study. 

           Williams and Mark Jensen, professor of rehabilitation medicine at the University of Washington School of Medicine, observed that some individuals appear to benefit more from specific treatments. They said one next research step would be to try to match individuals to the treatment more likely to provide benefit. To that end, they will be starting a new study this fall that includes both veterans and nonveterans in the community, and expands the interventions to telehealth delivery. The focus of that study would be to learn ways to match patients to the treatments most likely to benefit them.

           To read the original report, find it with this reference:

Williams, R.M., Day, M.A., Ehde, D.M., Turner, A. P., Ciol, M.A., Gertz, K.J., Patterson, D., Hakimian, S., Suri, P., Jensen, M.P., (2022). Effects of Hypnosis vs Mindfulness Meditation vs Education on Chronic Pain Intensity and Secondary Outcomes in Veterans: A Randomized Clinical Trial. Pain. 10.1097/j.pain.0000000000002586. Advance online publication.

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