Chronically Living and how to make the most of it

What are the Evidence-Based Treatments for Chronic Pain?

August 23, 2021 Kelsey Season 2 Episode 9
Chronically Living and how to make the most of it
What are the Evidence-Based Treatments for Chronic Pain?
Show Notes Transcript

The National Institute for Health and Care Excellence in the U.K. put out a list of recommendations in April 2021, for the treatment of chronic pain, based on a meta-analysis of research in the area. In this episode we talk about the recommendations and what it could mean for the well-being of Chronic Pain Warriors.
In this episode we discuss:

  • 5 evidence-based treatment for chronic pain
  • what was not included as a recommendation and why
  • what we should do with this information

Remember that this podcast is for psychoeducation/health education only, and you should always consult with your healthcare team before making any lifestyle changes.
Here's the link to the full report by NICE.

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Kelsey Harris:

What if I told you that there are only five evidence based treatments for chronic pain? The National Institute for Health Care and excellence out of the UK did a meta analysis. And that's what they found. What are these five treatments? How can we incorporate them into our lives? That's what we're looking to in this week's episode of chronically living. I'm Kelsey Harris, a chronic illness warrior and a psychotherapist in training, on chronically living and how to make the most of it, we're providing tangible ways to improve the well being of spoonies. So get ready to make the most out of your life, even with that pesky chronic illness. Then right about the information that I'm going to tell you about today, it blew my mind. Like I almost couldn't believe it at first. So here's what happened. Back in June, I decided to attend this free online embodiment therapy summit. Now, as this episode airs, I will actually finish my master's program. And I can say that I'm a therapist, just in the process of registering, which is very exciting. When I attended the summit, I was obviously still in training. And there are a few reasons I decided to attend it. So first, I think that professional development is just really important, whether I'm in school or an ongoing, obviously. Second, I think that using the body and embodiment in therapy is quite useful and works really well with the type of therapy that I practice, which I'll get into a bit later. And third, Stephen C. Hayes, the founder of the type of therapy I practice, was one of the presenters there. The summit was also quite cool, because all the workshops were very experiential in nature. So I got to practice along with the other practitioners. And these are the same types of exercises I can use in therapy with my clients. And this was a virtual summit, by the way, with COVID restrictions still on, at least at that point. So that's the background. Now, the type of therapy I typically practice is called Acceptance and Commitment Therapy, which is a third wave, quote end quote, cognitive behavioral approach. And I'm not going to get into large detail on this episode about it, though I will in subsequent episodes, but I will say that one of the reasons I was drawn to it is because there is a huge amount of scientific evidence that it helps people with chronic illness and chronic pain. Now, I also do practice more traditional cognitive behavioral therapy with a bit of a mindfulness element to it. And also dialectical behavior therapy. I've also integrated aspects of their to therapy with some clients. I'm interested in existential therapy. And of course, I've done motivational interviewing as well. So well, I don't exclusively use ACT, that's the acronym short form, by the way, Acceptance and Commitment Therapy, it's ACT. It is what I primarily use. So now back to the summit. During the workshop run by Steven Hayes, he mentioned a study that came out of nice, which is the National Institute for Health and care excellence. So they're located in the UK. And this study said that there are only five evidence based treatments for chronic pain. And at top, this would be one of them, which is why he brought it up. And he was very clearly excited about this. And to be honest, so it was I. But then he gave an overview of what the five are. And I was really surprised. Of course, I've just mentioned that ACT is one and cognitive behavioral therapy or more commonly known as CBT. That's another one. Interesting that two types of psychotherapy are known to help with chronic pain management, which I wouldn't have expected. Then there was also exercise in acupuncture. And then finally, antidepressants, and those are the only five treatments for chronic pain with a sufficient evidence base behind them. After the break, we're going to go into each of them in a bit more detail. Hey, warriors, what if it was possible to get local fresh groceries delivered right to your front door, you could take a deep sea yoga with all that free time. Well instacart gives you unlimited grocery delivery for one low monthly fee. This is definitely better than paying for delivery on all those other apps. Forget that one ingredient you needed to make that super healthy smoothie instacart can deliver to your dorton as little as an hour, you can shop multiple stores, getting all your favorites on a single order. Instagram even highlights deals so that you can save money. Get all the products you love hand selected by shoppers based on your preferences. They'll pick the freshest produce, and they'll keep your eggs safe to find everything you usually buy and get smart suggestions on new items. To get free delivery on your first order over $10 Follow the link in the show notes to let instacart know that we sent you and help to help support the show. With instacart, you'll never step foot in the grocery store again, I decided to actually go and look up the recommendations made by nice. Their information was gathered from a meta analysis, I think it was a huge amount of analysis. But I guess when you break it down into each category wasn't big. But overall, it was quite large, and amount of analysis just for anybody who doesn't know, it's basically a review of a bunch of literature studies on the subject. And usually they look at just between certain date ranges, most likely fairly recent ones, because that gives you the most accurate information. So the first section in the recommendations is about how to assess for chronic pain. And this includes using a person centered approach which includes having patients actively participate in their care and evaluation, which I think something that's often lacking in our healthcare system. And then thinking about possible causes for pain. So including both injury and disease. And knowing that primary and secondary chronic pain can coexist. And there's talking about the pain and how it affects the life of the patient, and how the life of the patient affects pain. So in other words, going over that body mind connection with the patients with us basically. Next is providing advice and information, which I think is fairly straightforward, developing a care and support plan and that is to include the patient again in the decision making process. And then finally dealing with flare ups as they come along. Because we obviously most of us can't really predict when we're going to have flares. The second section is about managing chronic primary pain. So this is the section with the five evidence based treatments I mentioned earlier. So it starts with non pharmacological management of chronic pain. The first recommendation is exercise and physical activity that is tailored to people's specific needs, and encouraging them to do physical activity. The research behind this found that exercise, reduce pain and improve the quality of life of the people study compared with care as usual. And care visual, we know it was typically just drugs pharmacological treatment. The additional benefit of exercise is that it is cost effective. So it's great. The difficulty for many of you listening is that you might find it difficult to go do physical activity because of your pain or because other issues, which is why they recommend that it's tailored to you, and that you try to sustain it over a long time. In other words, maybe you're not just doing exercise for a short period of time, you're doing it over many years. So the next recommendation was psychological therapy for chronic pain. And again, this included ACT and CBT is the only two types with a recommendation specifically not to use biofeedback. For ACT, they found it improved quality of life and sleep and reduce pain and psychological distress. And it again is a more cost effective strategy. CBT also improved quality of life. Now the CBT use would have to be tailored specifically to pain management, and is also cost effective. They did note that ACT and CBT are equal in their evidence base so they wouldn't recommend one over over the other necessarily. Next, we have acupuncture for chronic pain, which is to be delivered by a healthcare professional with the appropriate training and delivered in community setting. They also recommended only five hours of acupuncture on however many sessions it takes to get to that five hours, there's just no evidence that over five hours will provide the extra benefit. It's just up to that five hours. And they found that acupuncture, reduce pain and improved quality of life for up to three months. So it's a short term benefit and it may not have long term effects. There seems to be insufficient evidence for the long term benefits but definitely not short term that three months. Nice stated that tends ultrasound and interferential therapy are not recommended because They don't have an evidence base. And then as far as pharmacological treatment goes, they recommend antidepressants. So there's a list of specific ones, most of them are SSRIs. And one of them is an SNRI. And these all improve quality of life pain, sleep, and psychological distress. So most of this evidence did come from women with fibromyalgia so hard to say how applicable is with other chronic pain conditions, but certainly we know that Fibromyalgia is quite common. So that's probably why most of those studies were focused on that population. Now, to me, it makes sense that an antidepressant would help because mood and pain are controlled by the same region of the brain, which is the prefrontal cortex. And I also should mention that all these recommendations are for people ages 16 Plus, except for the antidepressants, which is for people ages 18 plus. Now my bonus Patreon content for subscribers this week is going to be a bit more than the hexa flex enact. If you don't know what that means, then you should probably subscribe to find out. In the meantime, what about pain medication was too. In fact, the recommendations are to not prescribe any of the following to people with chronic primary pain, ages 16 plus anti epileptic drugs, including gabapentinoids, anti psychotic drugs, benzodiazepines, corticosteroid trigger point injections, which I've had, by the way, didn't help ketamine local anesthetics, local anesthetic, corticosteroid combination injections, non steroidal anti inflammatory drugs so NSAIDs, which I was lso on for a number of years ntil they destroyed my stomach, pioids. And this one is a ittle bit frightening that hey're saying don't recommend pioids because they are rescribed to so often for hronic pain. And paracetamol hould be noted that pre goblins hat's Lyrica brand name was lso not recommended. And that edical marijuana doesn't have a ufficient evidence base either hough, they did state that with edical marijuana, and they idn't actually do enough esearch on it. So more unknown. o this is all due to a lack of vidence for these medications s effectively managing people's rimary chronic pain. And then hey give a few additional easons that they, on top of the ack of evidence that they ouldn't recommend some of these rugs. So they said that opioids re addictive as are abapentinoids. And, and NSAIDs a d benzodiazepines can actually c use poor physical and p ychological functioning, which a ain, is a bit frightening. And s I also want to note that this w s all very highly c ntroversial within the medical c mmunity, because doctors, as w all know, push prescription m dications all the time, take t is medication, you'll feel b tter. And for a lot of s mptoms, that's true, it just f r pain, what they're saying i , is it may not be and it s ems that like more holistic a proaches really need to be c nsidered for effective pain m nagement and pain reduction. S with all that being said, I a not saying to stop your pain m dication. Please, please, p ease always talk to your d ctor and other health care p ofessionals first. Some m dications, even if you do d cide to stop them, you a tually need to be weaned off o them. So things like opioids, r ght? There are a lot of r asons you need to talk to your d ctor first, please, please p ease, no matter what you take f om this episode today, speak t your health care team. What I t ink is a good idea. And what I s arted doing a few years ago w s adding the holistic p oaches. So add them first b fore you make any other d cisions, see if they help. And t en if you decide you want to m ke some decisions about w ether to stay on medications o you know, switch up a dose or s mething like that, then talk t your doctor at that point. B t start by adding some h listic approaches if you h ven't already. So again, t ings like exercise acupuncture o psychotherapy that is s ecifically targeted to pain m nagement. Food for thought, a d if you're feeling a bit o erwhelmed by this information, I will going to normalize it for y u And say that I did too. And p obably most people listening, d de, I actually talked to my m m about it after I read the a ticle. And we had to process t gether a bit. So maybe find s meone you could talk to about a l this. And I'm going to link t e recommendations in the show n tes so that you can just read t em for yourselves if you're i terested in and really, I o viously did a lot of s mmarizing here. It's quite l ng to read everything if e pecially if you go into all t e sub links within the a ticles, which I recommend d ing if you're really looking t , to get all the information. And I'm positive there are a lot of mixed thoughts and emotions out there about all of this. So let's take a minute to reflect. What did you notice about your thoughts and feelings as you listen to the episode? What is sticking out for you? And what are you noticing now as you reflect on that noticing? Alright, everyone, take care and keep making the most of it. Special thanks to Nicole Skura or the original music and to harity Williams for original rtwork.