Emotional Awareness and Expression Therapy for Chronic Musculoskeletal Pain
A study of 53 veterans with chronic musculoskeletal pain demonstrated that emotional awareness and expression therapy (EAET) was superior to cognitive-behavioral therapy (CBT) in significantly lowering pain severity.
The participants had a mean age of 73.5 years, with 92.4% of them male. They were randomized to either EAET or CBT. For both groups, the therapy was delivered as 1 individual 90-minute session and 8 group sessions that also were 90 minutes.
Pain severity was the primary outcome measured, along with pain interference, anxiety, and other secondary outcomes, all of which were assessed at baseline, posttreatment, and 3-month follow-up.
The authors found that EAET produced significantly lower pain severity than CBT at posttreatment and follow-up. At posttreatment, 41.7% of EAET patients had greater than 30% pain reduction, one-third had greater than 50% pain reduction, and 12.5% had greater than 70% pain reduction. Only 1 CBT patient achieved at least 30% pain reduction. Small to medium effect was shown in secondary outcomes, although only posttreatment anxiety reached statistical significance.
Although this trial is small, the results support prior research suggesting that EAET may be a treatment of choice for many patients with chronic musculoskeletal pain. Substantial pain reduction may be achieved by psychotherapy if pain neuroscience principles are emphasized and avoided emotions are processed. (See Yarns BC, Lumley MA, Cassidy JT, et al. Emotional awareness and expression therapy achieves greater pain reduction than cognitive behavioral therapy in older adults with chronic musculoskeletal pain: a preliminary randomized comparison trial [published online ahead of print May 25, 2020]. Pain Med. doi:10.1093/pm/pnaa145.)
Repeat Dosing of Dexamethasone Provides Sustained Pain Relief After Total Hip Arthroplasty
A study of 150 patients who underwent total hip arthroplasty concluded that additional doses of dexamethasone provided sustained pain relief and inflammatory control.
The authors randomized patients who were scheduled for total hip arthroplasty into 3 groups-A, B, and C. Group A would receive a single preoperative 10-mg dose of dexamethasone (A, n = 50). Group B would receive the preoperative dose and second dose 24 hours later, after surgery (B, n = 50). Group C would receive the preoperative dose plus another 2 doses at 24 and 48 hours (C, n = 50) after the total hip arthroplasty.
The primary outcome measured was postoperative pain level. The use of rescue and antiemetic medications was also followed, as were C-reactive protein and interleukin-6 levels, range of motion, and other complications.
Pain scores were lower for groups B and C on postoperative days 2 and 3 when compared with group A. A similar difference was seen between groups B and C on postoperative day 3. C-reactive protein and interleukin levels were lower in groups B and C at 48 and 72 hours than in group A. Group C had similarly lower levels than group B. Reduced rescue analgesic use and improved range of motion were found in groups B and C. No differences were observed among the groups regarding postoperative nausea and vomiting or other complications.
The researchers concluded that additional doses of dexamethasone provided sustained pain relief and inflammatory control. Moreover, the 3-dose regimen was more effective than 2 doses for pain and inflammatory control. (See Lei Y, Huang Z, Huang Q, et al. Repeat doses of dexamethasone up to 48 hours further reduce pain and inflammation after total hip arthroplasty: a randomized controlled trial [published online ahead of print June 17, 2020]. J Arthroplasty. doi:10.1016/j.arth.2020.06.023.)