Chronic Pain and Excercise

Therapy and exercise for pain sufferers

(RxWiki News) If you have chronic pain, your first instinct might be to reach for a painkiller. But a new study suggests that a non-pharmacological treatment might be better in the long term.

A team of British researchers put chronic pain patients on a regimen of phone-delivered cognitive behavioral therapy and exercise, in an attempt to find a cost-effective and successful treatment for the widespread condition.

They found that patients who did therapy and exercise programs, either separately or combined, felt better than patients who continued their usual treatment, at the end of six months.

"Ask your doctor about therapy and exercise as treatment options."

Twenty to forty percent of adults report experiencing chronic pain, and powerful opiate painkillers such as OxyContin and Vicodin are widely prescribed. But there is little evidence that these painkillers are successful in reducing long-term pain, according to an editorial published in The Archives of Internal Medicine alongside the study.

Cognitive behavioral therapy (CBT) is a form of therapy that emphasizes that how we think influences how we feel. The idea is that CBT will give patients techniques to cope with pain symptoms. Many chronic pain sufferers feel helpless to their symptoms, and being able to take mental control of how they feel physically puts them back in the drivers' seat to deal with their health.

The study authors chose to deliver CBT over the phone to make treatment more cost-effective and accessible to more people. Exercise has also been shown to be a promising treatment for pain in previous studies. But there had been no studies testing the efficacy of this multidisciplinary approach.

The study divided up 442 patients into four groups. One group received telephone-based CBT, another did an exercise program, one had both CBT and exercise, and the control group did a treatment as usual, as provided by their own doctors. The study lasted six months, with results gathered from a questionnaire answered by the patients at the end.

A positive outcome was defined by the patients answering that their health was “much better” or “very much better.” The group that received both telephone-based CBT and exercise had the highest rate of positive outcomes, followed by the exercise group, then the CBT group, and the control group.

A nine-month follow-up demonstrated similar scores. The study authors, led by Dr. John McBeth, concluded that telephone-based cognitive behavioral therapy and exercise create improvements for patients for the short- to medium-term, but more research is needed to establish long-term benefits.

The accompanying editorial by Dr. Seth Berkowitz is optimistic about CBT and exercise as alternatives to powerful and potentially dangerous opiate painkillers.

He writes, “As practicing physicians who treat many patients with chronic pain, we welcome additional research that seeks to minimize the use of pharmacotherapy, with its unclear efficacy and attendant consequences, in favor of a regimen that focuses, in a truly patient-centered way, on teaching skills for self-management of symptoms and return to meaningful lives.”

The study and the editorial were published in November 2011.

Review Date: 
November 14, 2011