Pain task force endorses alternatives to opioids

UW Health News Jan 30, 2018

Acupuncture, tai chi, yoga, music therapy, massage, and mindfulness, once considered alternative therapies, have earned the endorsement of a national task force on pain relief.

The Academic Consortium for Integrative Medicine and Health, a 72-member organization, recently published a 74-page white paper stating that these nonpharmacological options are highly effective for treating pain. The report addresses "the dual crisis of pain care and opioids" in the United States and offers evidence for effective treatment of post-surgical pain, acute inpatient pain, cancer pain, and chronic pain.

Dr. Heather Tick, a clinical associate professor of family medicine and of anesthesiology and pain medicine at the University of Washington School of Medicine, is the lead author of the paper calling for a reform in pain treatment. Co-authors include members from Harvard Medical School and the schools of medicine at the University of Pittsburgh, University of California, and University of Wisconsin.

The authors used systematic reviews and meta analyses to identify evidence-based nonpharmacological pain-treatment strategies. For example, they found that acupuncture after total knee arthroplasty reduced pain and was associated with delayed opioid use. They also found acupuncture helped with back pain. They said the literature showed that music therapy reduced pain in burn patients and in pediatric post-operative pain. Also, they found that massage therapy and mindful-based courses were effective for pain in cancer patients. And, they said tai chi was effective in dealing with chronic pain and osteoarthritis. The white paper details how to incorporate evidence-based nonpharmacological options in a variety of pain treatment.

"The aim of this is to provide comprehensive care," said Tick. She said patients should be seeking these treatments as a first-line strategy not after other options haven't worked.

The task force said it is widely acknowledged that opioids have not remedied chronic pain but rather have exacerbated it, as well as increased abuse, addiction, illness behavior, and disability.

The white paper notes that the authors' approach is aligned with recommendations of the National Institutes of Health, the National Pain Strategy, the National Academy of Medicine, the updated pain mandate from The Joint Commission, the US Food and Drug Administration, and the American College of Physicians. In parallel, 37 attorneys general have appealed to US health plans asking them to include and incentivize evidence-based nonopioid treatments for pain.

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