Update on Pain Management: 3 New Things

Mar 28, 2018

What’s new: cognitive behavioral therapy can combat opioid misuse, virtual reality provides an escape from pain, and an app helps prevent painful sports injuries.

References:

1. Van Denburg AN, Vilardaga JP, Shelby RA, Keefe FJ. Opioid therapy and persistent pain: can cognitive behavioral therapy help? Pain. 2018;159:411-415. doi: 10.1097/j.pain.0000000000001091.2. Indovina P, Barone D, Gallo L, et al. Virtual reality as a distraction intervention to relieve pain and distress during medical procedures: a comprehensive literature review. Clin J Pain. 2018 Feb 26. doi: 10.1097/AJP.0000000000000599.3. Wilkerson GB, Gupta A, Colston MA. Mitigating sports injury risks using internet of things and analytics approaches. Risk Analysis. March 12, 2018. doi:10.1111/risa.12984

Highlights of 3 new pain studies include: (1) cognitive behavioral therapy (CBT) can treat problematic patterns of opioid use in patients with persistent pain; (2) virtual reality can be used as a distraction intervention to alleviate pain and distress from medical treatments; and (3) the pain of sports injuries may be mitigated by a new analytic risk assessment approach.^1-3 Scroll through the slides for the latest findings and take-home messages.
(©Diego Cervo/Shutterstock.com)

With increasing dependence on opioids, patients with chronic pain become more vulnerable to stress and less able to manage psychological distress. Cognitive behavioral therapy (CBT) emphasizes the importance of identifying the behaviors, thoughts, and feelings that initiate and maintain a vicious cycle that may lead to opioid misuse.

A recent study of an online CBT coping skills intervention included 92 patients with persistent pain who took prescribed opioid medications. At the end of the 8-week trial, patients in a CBT group had significantly greater improvements in pain self-efficacy and fewer reports of opioid misuse than those in a wait list control group.¹

A stepped-care approach that considers the patient’s and provider’s goals when selecting CBT methods may be beneficial. Patients receive low-intensity interventions and then, based on response, are stepped up to receive increasingly specialized and costly treatments.

“Bolstering the CBT elements from addiction treatments (contingency management, relapse prevention, and mindfulness-based strategies) with CBT strategies for improving pain management may best serve these individuals for meeting their dual goals of improved coping with pain and reduced opioid use,” stated the researchers, led by Alyssa N. Van Denburg of Duke University Medical Center in Durham, NC.

A comprehensive overview of clinical trials investigated the use of virtual reality (VR) distraction during different medical procedures, such as burn injury treatments, chemotherapy, surgery, and dental treatment. The results show that VR has proved to be effective in reducing procedural pain even in patients subjected to extremely painful procedures, such as those with burn injuries undergoing wound care and physical therapy.²

“VR has proven to be very effective in relieving pain, even in patients subjected to extremely painful procedures, who do not receive proper relief with pharmacological treatments alone,” said senior author Antonio Giordano, MD, PhD, of the Sbarro Health Research Organization at Temple University, and University of Siena, Italy.

This approach categorizes injury risks by combining the athlete’s previous injury history and data from phones and devices with injury surveillance data and using cloud-connected smartphones and other devices to create a real-time “dashboard” of an athlete’s status.³

A cohort of 45 top college football players provided self-ratings of persistent effects of previous injuries and performed a single-leg postural stability test. Instantaneous change in body mass acceleration during the test was quantified by a smartphone accelerometer with data wirelessly transmitted to a secure cloud server.

Athletes who played at least 8 games were more than 3 times more likely to suffer an injury than those who played fewer than 8 games. Of those athletes who exhibited at least 1 risk factor, 42% sustained an injury.

“Assigning all athletes to a single type of training program, without consideration of an individual’s unique risk profile, may fail to produce a substantial decrease in injury likelihood. The results also provide a useful estimation of the odds of injury occurrence for each athlete during the subsequent season,” said lead author Gary B. Wilkerson of the University of Tennessee Chattanooga.