Mind-body therapies are among the nonopioid pain management options guidelines suggest to combat the opioid crisis. Researchers conducted a systematic review and meta-analysis to evaluate the efficacy of mind-body therapies in patients prescribed opioids for pain.
Randomized clinical trials of mind-body therapies were included if they involved adults who had been given opioids for chronic, acute, procedural, or cancer pain. The review was limited to mind-body therapies that prioritized the use to relieve pain of mental techniques-such as meditation, hypnosis, guided imagery, relaxation, therapeutic suggestion, and cognitive behavioral therapy. A total of 60 studies with 6,404 participants were included. Most studies used active or placebo controls and had low risk of bias.
The researchers found that mind-body therapies had a statistically significant, moderate association with reduced pain and a significant, small association with reduced opioid use. The strength of the evidence varied, depending on the therapy. The results suggest that mind-body therapies overall may be beneficial for a range of painful health conditions.
The efficacy of specific types of mind-body therapies varied. Most studies of meditation, hypnosis, and cognitive behavioral therapies showed significant therapeutic associations with opioid-related outcomes, including dosing, craving, and misuse. Comparatively fewer studies of suggestion, imagery, and relaxation therapies showed significant associations with opioid-related outcomes.
Heterogeneity of the studies limited the researchers' ability to draw quantitative conclusions. Some studies were missing clinical trial reporting information, whereas others had biases, according to the researchers. In addition, they note, there was insufficient reporting of opioid dosing.
Practitioners should consider prescribing mind-body therapies as adjuncts to opioid analgesics, the authors suggest. Meditation-based interventions and cognitive behavioral therapies may be particularly useful, they conclude.