Josephine P. Briggs, M.D.
Pain is a major public health concern in this country. Our most recent survey establishes that more than 25 million Americans experience pain every single day. From a health professional point of view, finding an effective way to manage pain can be a serious challenge. Pharmacologic approaches for pain management include nonsteroidal anti-inflammatory drugs, opioids, and other agents, and while these drugs may provide improvements in pain and function over the short term, evidence of long-term effectiveness is limited. Opioid prescriptions have been on the rise at an alarming rate, and their use has been associated with serious risks, including misuse and overdose.
Consequently, last week the Centers for Disease Control and Prevention issued guidelines for prescribing opioids for chronic pain. This is an important first step to help improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy. Nonetheless, the guideline development process highlights how little high quality evidence from rigorous trials is available to guide pain management (as shown in Table 1 of the guidelines).
Pain, particularly the nonpharmacologic management of pain, is a key focus of our research here at NCCIH. Mind and body approaches are showing promise in clinical trials and there is growing evidence that these techniques may be an effective complement to the use of medications for people with chronic pain. Results of an NCCIH-funded study published today in the Journal of the American Medical Association show that two mind and body practices—mindfulness based stress reduction (MBSR) and cognitive-behavioral therapy—resulted in greater improvement in pain and functional limitation compared to usual care in adults with chronic low-back pain. Incidentally, earlier this month, the Agency for Healthcare Research and Quality issued an evidence review on noninvasive treatments for low-back pain, and included many of the NCCIH-funded studies on complementary health approaches for low-back pain. The overall findings of the report are that these interventions provide modest benefits for pain and function and are generally safe.
Another study funded by our Center, published last week in the Journal of Neuroscience, had important new findings on how mindfulness meditation may work in the body to relieve pain. This study demonstrated that mindfulness meditation achieves its pain relief-effect without engaging the opioid receptors in the brain. These findings are very exciting, and if researchers can identify effective pain-relieving therapies that can bypass opioid receptors, that will be a major advancement in the pursuit of pain management.
In addition, the pain program in NCCIH’s Division of Intramural Research is making some important advances of its own, as it continues to examine the role of the brain in perceiving, modifying, and managing pain, and specifically investigating the role of the brain in pain processing and control, and how factors such as emotion, attention, and environment affect the perception of pain. Stay tuned for some exciting results coming out of this program. I encourage you to check out our Web site for more information on their ongoing research, as well as for information about complementary health approaches for chronic pain, results of NCCIH-funded studies, our eBook on pain and complementary approaches, a new continuing medical education opportunity pain in partnership with Medscape, and more.