Clinical Question

Are mind-body therapies, including meditation, hypnosis, and relaxation, effective for decreasing pain or affecting opioid use in patients with acute or chronic pain?

Bottom Line

Using mindfulness, meditation, hypnosis, therapeutic suggestion, and cognitive behavior therapy, in addition to opioid treatment of acute or chronic pain, provides an additional benefit to patients by reducing pain scores. Some of these interventions will decrease the duration or amount of opioid needed. (Level of Evidence = 1a)

Synopsis

To assemble randomized controlled trials to combine for this meta-analysis, the researchers searched six databases, including the Cochrane Library, for English-language articles on mind-body therapies. They also searched bibliographies of retrieved articles and the websites of the Agency for Health Care Quality and Research, American Psychological Association, and the World Health Organization. Two authors independently selected studies for inclusion, extracted the data, and assessed the risk of bias. They identified 60 studies of 6,404 participants that evaluated mind-body approaches on procedural pain, burn pain, cancer pain, and chronic pain. Most studies were at low risk of bias because of their designs. Pain intensity was reduced by a moderate to large amount with meditation (mindfulness), hypnosis, therapeutic suggestion (suggestions to change thoughts, emotions, or sensations without inducing hypnosis), and cognitive behavior therapy. Meditation, cognitive behavior therapy, and hypnosis also decreased opioid-related outcomes such as opioid misuse, opioid craving, and time to opioid cessation (acute pain). There was a high degree of heterogeneity among the studies regarding the size of the effect. Studies that did not show benefit of meditation and therapeutic suggestion may not have been published (i.e., publication bias may have occurred, amplifying the actual benefit of these approaches).

Study design: Meta-analysis (randomized controlled trials)

Funding source: Government

Setting: Various (meta-analysis)

Reference: Garland EL, Brintz CE, Hanley AW, et al. Mind-body therapies for opioid-treated pain: a systematic review and meta-analysis. JAMA Intern Med. 2020;180(1):91–105.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.