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

doi:10.1001/jama.276.4.313

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 journal › Article › peer-review

301 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 language	English
Pages (from-to)	313-318
Number of pages	6
Journal	JAMA
Volume	276
Issue number	4
DOIs	https://doi.org/10.1001/jama.276.4.313
State	Published - 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.

Funding

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). 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.

Funders
Department of Social Medicine
John D. MacArthur Professor of Health Policy Emeritus
Mayo Medical School
South Australian Health and Medical Research Institute
National Insti-tutes of Health
National Institute ofDental Research
Neuromuscular Disorders
U.S. Department of Energy Office of Energy Efficiency and Renewable Energy Bioenergy Technologies Office
Office of Alternative Medicine
Office of Medical Ap-plications
Office of Medical Applications of Research
Public Affairs Officer
National Institutes of Health (NIH)
National Institute on Aging
National Heart, Lung, and Blood Institute (NHLBI)
National Childhood Cancer Registry – National Cancer Institute
National Institute of Nursing Research
National Institute of Neurological Disorders and Stroke
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Mayo Clinic Rochester
Harvard Medical School
Office of Extramural Research, National Institutes of Health
Emory University School of Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

General Medicine

Access to Document

10.1001/jama.276.4.313

Cite this

Richmond, J., Berman, B. M., Docherty, J. P., Goldstein, L. B., Kaplan, G., Keil, J. E., Krippner, S., Lyne, S., Mosteller, F., O'Connor, B. B., Rudy, E. B., Schatzberg, A. F., Benson, H., Blanchard, E. B., Bradley, L. A., Buysse, D. J., Crawford, H. J., Dement, W. C., & Fields, H. L. (1996). Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. JAMA, 276(4), 313-318. https://doi.org/10.1001/jama.276.4.313

@article{0c960a7305464769b35a2d6eff01f6c4,

title = "Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia",

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.",

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

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.",

year = "1996",

doi = "10.1001/jama.276.4.313",

language = "English",

volume = "276",

pages = "313--318",

number = "4",

}

Richmond, J, Berman, BM, Docherty, JP, Goldstein, LB, Kaplan, G, Keil, JE, Krippner, S, Lyne, S, Mosteller, F, O'Connor, BB, Rudy, EB, Schatzberg, AF, Benson, H, Blanchard, EB, Bradley, LA, Buysse, DJ, Crawford, HJ, Dement, WC & Fields, HL 1996, 'Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia', JAMA, vol. 276, no. 4, pp. 313-318. https://doi.org/10.1001/jama.276.4.313

TY - JOUR

T1 - Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia

AU - Richmond, J.

AU - Berman, B. M.

AU - Docherty, J. P.

AU - Goldstein, L. B.

AU - Kaplan, G.

AU - Keil, J. E.

AU - Krippner, S.

AU - Lyne, S.

AU - Mosteller, F.

AU - O'Connor, B. B.

AU - Rudy, E. B.

AU - Schatzberg, A. F.

AU - Benson, H.

AU - Blanchard, E. B.

AU - Bradley, L. A.

AU - Buysse, D. J.

AU - Crawford, H. J.

AU - Dement, W. C.

AU - Fields, H. L.

N1 - 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.

PY - 1996

Y1 - 1996

N2 - 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.

AB - 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.

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

Abstract

Bibliographical note

Funding

UN SDGs

ASJC Scopus subject areas

Access to Document

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