Cognitive/behavioral approaches: Opioid use reduction as a secondary effect of comprehensive pain management programs

Abstract

This paper/poster defines different origins of chronic pain (nocioceptive, neuropathic, and idiopathic) and what opioid analgesics (morphine, oxycodone, fentanyl, and levorphanol) are commonly used in treatment. Pros and cons are presented for using opioids for the treatment of chronic pain in reference to physical and psychological dependence as well as tolerance. The controversy surrounding prescribing opioids is described in detail. This paper/poster is intended to show how comprehensive pain management programs can serve as an alternative to opioid use and thus, by participating in one of these programs, could prevent addiction to opioid medications (as a secondary benefit). The components of these programs are discussed in detail and include education (physiological and psychological aspects of pain), skills acquisition (progressive relaxation training and biofeedback), the promotion of adaptive cognitions (via cognitive restructuring, visualization, and imagery techniques), a structured exercise program, medication management, and social reinforcement for healthy behaviors. A review of the literature is presented that supports comprehensive pain management programs. These programs are acknowledged to decrease psychological distress, (decrease catastrophizing and increase self-management skills), reduce pain behavior and intensity of pain (through an increase in activity levels), as well as lower health-related disability (decreased disability level and increased work readiness). This paper also reveals the results of several studies reviewed on comprehensive pain management programs that verify decreased or extinguished use of opioid, analgesic drugs. Although this was not the main focus of their studies, it does lend support that the programs show efficacy and efficiency as a secondary benefit in offering prevention of addiction to these drugs. Limitations (generalizability, recency of these studies, population used) as well as future directions (what a study where the main focus is on decreased drug use might look like) are offered.