The U.S. Department of Health and Human Services' 2019 Pain Management Best Practices Task Force Report highlights a significant shift in addressing pain management. It calls for integrating behavioral interventions into acute, chronic, and post-surgical pain care. These interventions, including cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR), offer promising results in alleviating pain levels, reducing medication dependency, enhancing mobility, and improving overall medical outcomes, often without risks or side effects.
Despite their effectiveness, behavioral interventions remain underutilized in pain management strategies. The opioid misuse epidemic has underscored the need for alternative approaches, as conventional treatments like opioids have proven inadequate for chronic pain. Opioids, often no more effective than placebos, have contributed to a crisis claiming over 280,000 lives since 1999, with 17,000 deaths in 2021 alone. Behavioral interventions present a viable solution, offering a nuanced approach that addresses the complex nature of chronic pain.
Behavioral interventions are not mere psychotherapies for imagined pain but are grounded in the understanding that all pain is processed in the brain. Amanda Green clarifies this misconception:
"The truth is, all pain is processed in the brain. And I think there is a natural tendency for people's immediate response to be defensive about that as if we are saying the pain is 'all in their head.' But that is not the case."
These interventions help patients reframe their experience of pain, enabling them to manage it more effectively. Shelly Spears, a former Masters level amateur tennis player, exemplifies the impact of such therapies. Suffering from debilitating chronic pain, she combines behavioral interventions with medication to regain her mobility and independence.
"I was not able to take care of myself. I couldn't lift, I couldn't bend, I couldn't sit more than 5 minutes. I couldn't stand more than 5 minutes," – Shelly Spears.
Spears acknowledges that managing her pain requires ongoing effort:
"It's not a magic bullet. I have to work at it every day."
Behavioral interventions like CBT typically involve 8 to 10 one-hour sessions, costing up to $200 per session. This resource-intensive approach can limit accessibility for many patients. However, Empowered Relief offers a more accessible alternative. This single-session, two-hour online program provides evidence-based care with lasting effects up to six months. Sara Davin emphasizes its potential:
"One-session behavioral pain treatment is a huge shift and it suddenly makes it possible for people to receive this evidence-based care in a scalable way, especially in a surgical context, where longer behavioral interventions are often impractical."
The Veterans Health Administration has embraced CBT for chronic pain nationwide, setting an example for integrating behavioral therapies into conventional healthcare settings. Such programs help patients understand that pain is not necessarily indicative of further damage but rather a sensation manageable through various techniques.
Beth Darnall explains that chronic pain often has a medical basis in serious illnesses or injuries:
"It has a medical basis, sometimes in very serious illness or injury — cancer, ankylosing spondylitis, rheumatoid arthritis, degenerative diseases with no cure that get worse over time."
Yet the goal of behavioral interventions is to reset how patients' nervous systems respond to pain:
"What we're doing, at a very basic level, is help people reset how their nervous system responds to pain, which changes their experience of pain," – Beth Darnall.
Amanda Green further elaborates on the objective of these therapies:
"We're trying to turn off that fight or flight response."
Sean Mackey reassures patients that engaging in activities like tennis is safe despite potential discomfort:
"Yeah. You can play tennis all you want. It's gonna hurt, but you're not gonna harm yourself."
The current culture of medicine often views pain as a straightforward issue, yet it requires a more nuanced approach. Behavioral interventions align with best practices and standards of care in modern medicine. Beth Darnall stresses the importance of recognizing their scientific backing:
"It's not that complicated. It's all about just making a simple point and really emphasizing that this is best practice. It's the standard of care. We have to emphasize that there is science supporting this. These are highly effective interventions that can help with serious pain."
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