Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia

J. Richmond, B. M. Berman, J. P. Docherty, L. B. Goldstein, G. Kaplan, J. E. Keil, S. Krippner, S. Lyne, F. Mosteller, B. B. O'Connor, E. B. Rudy, A. F. Schatzberg, H. Benson, E. B. Blanchard, L. A. Bradley, D. J. Buysse, H. J. Crawford, W. C. Dement, H. L. Fields

Research output: Contribution to journalArticlepeer-review

290 Scopus citations

Abstract

Objective. - To provide physicians with a responsible assessment of the integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. Participants. - A nonfederal, nonadvocate, 12- member panel representing the fields of family medicine, social medicine, psychiatry, psychology, public health, nursing, and epidemiology. In addition, 23 experts in behavioral medicine, pain medicine, sleep medicine, psychiatry, nursing, psychology, neurology, and behavioral and neurosciences presented data to the panel and a conference audience of 528 during a 1 1/4 - day public session. Questions and statements from conference attendees were considered during the open session. Closed deliberations by the panel occurred during the remainder of the second day and the morning of the third day. Evidence. - The literature was searched through MEDLINE, and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. Assessment Process. - The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. Conclusions. - A number of well-defined behavioral and relaxation interventions now exist and are effective in the treatment of chronic pain and insomnia. The panel found strong evidence for the use of relaxation techniques in reducing chronic pain in a variety of medical conditions as well as strong evidence for the use of hypnosis in alleviating pain associated with cancer. The evidence was moderate for the effectiveness of cognitive-behavioral techniques and biofeedback in relieving chronic pain. Regarding insomnia, behavioral techniques, particularly relaxation and biofeedback, produce improvements in some aspects of sleep, but it is questionable whether the magnitude of the improvement in sleep onset and total sleep time are clinically significant.

Original languageEnglish
Pages (from-to)313-318
Number of pages6
JournalJAMA
Volume276
Issue number4
DOIs
StatePublished - 1996

Bibliographical note

Funding Information:
Preparation and distribution of this statement is the responsibility of the Office of Medical Applications of Research of the National Institutes of Health. Free cop- ies of this statement with bibliography as well as all other available NIH Technology Assessment State- ments and NIH Consensus Statements may be obtained from NIH Consensus Program Information Cen-ter, PO Box 2577, Kensington, MD 20891, or call toll-free (888) NIH-CONSENSUS (644-2667). Full-text versions of all these statements are also available on- line through the Internet using Gopher (gopher:// gopher.nih.gov/Health and Clinical Information), file trans- fer protocol (ftp://public.nim.nih.gov/hstat/ nihcdcs), or the World Wide Web (http://text.nIm.nih. gov/nih/nih.html).

Funding Information:
Medicine, Deaconess Hospital, Associate Professor of Medicine, Mind/Body Medical Institute, Boston, Mass; Jerry M. Elliott, Program Analyst, Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md; John H. Ferguson, MD, Director, Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md; Richard Gracely, PhD, Research Psychologist, Neuropathic and Pain Measurement Section, Neu-robiology and Anesthesiology Branch, National Institute ofDental Research, National Institutes of Health, Bethesda, Md; Anita Greene, MA, Public Affairs Officer, Office of Alternative Medicine, National Institutes of Health, Bethesda, Md; J. David Haddox, DDS, MD, Assistant Professor of Anesthesiology and Psychiatry, Emory University School of Medicine, Atlanta, Ga; William H. Hall, Director of Communications, Office of Medical Ap-plications of Research, National Institutes of Health, Bethesda, Md; Peter J. Hauri, PhD, Professor of Psychology, Mayo Medical School, Director, Insomnia Program, Department of Psychology, Sleep Disorders Center, The Mayo Clinic, Rochester, Minn; Peter G. Kaufrnann, PhD, Group Leader, Behavioral Medicine Scientific Research Group, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md; James P. Kiley, PhD, Director, National Cen-ter on Sleep Disorders Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md; Mary D. Leveck, PhD, RN, Health Scientist Administrator, Division of Extramural Programs, National Institute of Nursing Research, National Institutes of Health, Bethesda, Md; Charlotte B. McCutchen, MD, Medical Officer, Epllepsy Branch, Division of Convulsive, Develop- mental, and Neuromuscular Disorders, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md; Andrew A. Monjan, PhD, MPH, Chief, Neurobiology of Aging Program, Neuroscience and Neuro-psychology of Aging Program, National Institute on Aging, National Institutes of Health, Bethesda, Md; Stanley R. Pillemer, MD, Medical Officer, Office of Prevention, Epidemiology, and Clinical Applications, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Insti-tutes of Health, Bethesda, Md; Julius Richmond, MD, Conference and Panel Chairperson, The John D. MacArthur Professor of Health Policy Emeritus, Department of Social Medicine, Harvard Medical School, Boston, Mass; Charles Sherman, PhD, Deputy Director, Office of Medical Applica- tions of Research, National Institutes of Health, Bethesda, Md; John Spencer, PhD, Program Analyst, Office of Alternative Medicine, National Institutes of Health, Bethesda, Md; Claudette G. Varricchio, DSN, RN, Program Director, Com-munity Oncology and Rehabilitation Branch, Divi- sion of Cancer Prevention and Control, National Cancer Institute, National Institutes of Health, Bethesda, Md.

ASJC Scopus subject areas

  • General Medicine

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