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New research shows that behavioral therapy combined with an exercise program may be the most effective treatment for chronic pain.
EFFECTIVE NEW TREATMENT FOR CHRONIC PAIN
According to the American Academy of Pain Medicine, chronic pain afflicts nearly 1 out of every 3 American men, women and children, and is associated with an estimated cost to society of $560 to $635 billion per year. While there are many causes of chronic pain, they all share a common trait in that almost all types of chronic pain are associated with significant physical and psychological disability in afflicted patients.
Unlike acute pain (like the pain that follows a fresh cut on your hand, or spraining your ankle, for example), which subsides very quickly, chronic pain usually does not improve on its own. Moreover, while you may hop around and shout out a few choice words after smashing your thumb with a hammer, the acute pain caused by a poorly aimed hammer usually does not leave a person feeling depressed or completely disabled like chronic pain so often does. Over time, as chronic pain persists, the area in the brain (the limbic system) that attaches emotional content or value to our experiences and sensations becomes increasingly involved with interpreting the chronic barrage of pain sensations from damaged nerves or chronic inflammation, which leaves many chronic pain sufferers debilitated, and often depressed. Because of the biological complexity of chronic pain, when compared to acute pain, it can be very difficult to effectively treat this lingering form of pain. Patients suffering with chronic pain frequently find their symptoms both physically and emotionally disabling, and medications commonly used to treat acute pain are often ineffective in managing chronic pain. As I have noted, depression is a common feature of chronic pain, and often requires treatment with antidepressant medications and behavioral therapy in addition to treating the original cause (or causes) of a patient’s pain.
Now, a newly published prospective randomized clinical research study offers new hope for the estimated 116 million Americans who suffer from chronic pain. This study, which appears in the current issue of the Archives of Internal Medicine, randomized 442 patients with chronic pain to receive one of the following interventions for a period of 6 months: (1) telephone-based behavioral therapy, (2) a graded, step-wise exercise program, (3) a combination of both telephone-based therapy and a graded exercise program, or (4) standard treatment for chronic pain. All of the study volunteers were assessed at the time that they entered into the study, 6 months later, and again at 9 months.
The results of this innovative study were quite interesting. Following 6 months of standard chronic pain management, only 8 percent of the study volunteers randomized to this intervention group noticed any significant improvement in their symptoms, and this result was unchanged 9 months after the start of this clinical study. Among the patients who underwent 6 months of telephone-based behavior therapy, 33 percent felt that their chronic pain was improved at 9 months. After 6 months of treatment, 35 percent of the patients who participated in a graduated exercise program felt improved, although this effect decreased over time, with 24 percent of this group of patients reporting improvement in their chronic pain symptoms at 9 months. Finally, the combined therapy group (behavioral therapy and exercise) experienced the greatest improvement in their symptoms, compared to the other treatment groups, with 37 percent of patients in this group reporting significant improvement at both 6 months and 9 months.
This study represents an extremely important advance in the management of chronic pain, a condition that is highly resistant to most conventional therapies and medications. As a cancer physician who regularly treats cancer patients with chronic pain, I am not surprised by the extremely poor response of patients to conventional chronic pain management approaches in this study. While the 37 percent positive response rate noted in this study to combination therapy may seem like a rather poor result, chronic pain syndromes are so difficult to effectively treat that this study’s 37 percent response rate is actually extremely impressive. Based upon the results of this important study, behavioral therapy combined with exercise therapy appears to be the most effective and long-lasting treatment approach for patients with chronic pain. At the same time, the dismal response rate associated with standard chronic pain management approaches, as noted in this study, should cause pain management specialists to seriously reevaluate current methods of treating patients with chronic pain.
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Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity
Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author
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