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Observations

Opinion, arguments & analyses from the editors of Scientific American

Phone Calls and Exercise Make Pain Treatments More Effective

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woman on phone with pain

iStockphoto/YanLev

Chronic pain affects at least a fifth of the U.S. population, yet many of these people remain in significant physical discomfort whether they receive treatment or not. Even strong drugs, such as opioids, are often not up to the task, which is one of the reasons why researchers are looking to other avenues to treat this ailment.

A new study finds that adding a relatively low-cost phone-based therapy and/or a semi-regular exercise program can greatly diminish pain levels reported by patients. And that could help them feel better overall and cut back on fog-inducing or otherwise unpleasant pain medication as well as costly doctor visits.

The phone-based intervention lasted six months and employed cognitive-behavioral therapy in 10 sessions, lasting an hour or less each. These tailored chats gave patients mental tools to change their behaviors and attitudes toward their pain. Those in the exercise program worked with a fitness instructor to complete suitable cardio workouts for 20-60 minutes at least twice a week, which were supplemented with daily activities such as walking.

More than 440 patients with fibromyalgia, a syndrome that can involve pain throughout the body, were randomly assigned to one of four treatment plans. Only about 8 percent of those who received just a standard treatment (based on what their family doctor prescribed, such as pain medications) reported feeling better in six or nine months. A quarter of patients who also received the phone-based cognitive-behavioral therapy felt better after nine months. About a third of patients who exercised at least two days a week (coordinating with a trained instructor) in addition to standard treatment reported improvements. And 37 percent of patients who participated in both the therapy and exercise programs in addition to standard therapy said they felt much better—or "very much better"—by the end of the study. The findings were published online Monday in Archives of Internal Medicine in a study led by John McBeth, of the University of Manchester's Arthritis Research UK Epidemiology Unit.

Extra interventions add to the initial cost of treatment, but the overall cost could be much lower if patients feel better and the need for pain medication is reduced or eliminated. Currently, fibromyalgia tacks on almost $3,500 in health care costs in the first six months after diagnosis.

Currently three drugs are approved in the U.S. to help treat pain associated with the disorder (Cymbalta, Savella and Lyrica), but none of them has proven to be a panacea. "There is little evidence that long-term opioid use is efficacious in reducing pain, much less in restoring function, the true goal of treatment," Seth Berkowitz and Mitchell Katz, physicians at the Los Angeles County Department of Health Services, wrote in an essay published in the same issue of Archives. So "non-opioid-based alternatives to chronic pain management are desperately needed," Berkowitz and Katz argued. And relying on drugs can also become psychologically debilitating and habit-forming, they noted. "A [cognitive-behavioral therapy] and exercise based regimen gives control over symptoms back to the patient."

The views expressed are those of the author and are not necessarily those of Scientific American.

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