Treatments May Be Cheaper Than Medication
By Rita Rubin
WebMD Health News
Reviewed by Laura J. Martin, MD
About 20% to 40% of adults report experiencing chronic pain, Seth Berkowitz, MD, and Mitchell Katz, MD, of the Los Angeles County Department of Health Services write in an accompanying editorial. Up to 20% of visits to a primary health care provider generate a prescription for a narcotic painkiller, or opioid, they say.
While three non-opioid drugs -- Cymbalta, Lyrica, and Savella -- have been approved by the FDA to treat fibromyalgia pain, none adequately controls the disorder's multiple symptoms, the authors of the new study write.
The scientists assigned almost 450 patients with chronic widespread pain, some of whom had fibromyalgia, to get either "talk therapy" by phone, exercise, both talk therapy and excerise, or their usual treatment.
Four therapists underwent three days of training to learn how to provide psychological help to study participants receiving talk therapy. Patients chose goals, such as identifying and evaluating unhelpful thinking styles or making lifestyle changes.
After an initial assessment that lasted an hour, those participants receiving talk therapy spoke on the phone with a therapist for 30 to 45 minutes once a week for seven weeks. That was followed by a phone session three months and six months after the study began.
Evidence suggests that this talk therapy delivered by phone is as effective as face-to-face therapy, researcher John McBeth, PhD, an epidemiologist at the University of Manchester, tells WebMD in an email.
Those in the exercise group were invited to meet with a fitness instructor once a month for six months. The goal was to improve their fitness by exercising 20 minutes to an hour at least twice a week.
Three months after the study ended, the phone therapy and/or exercise patients showed more improvement than those who'd stayed with their usual care.
The people who engaged in both talk therapy and exercise did only slightly better than those who received one or the other. Perhaps the therapists included messages about exercise, the authors speculate. Or, they write, perhaps each treatment was so effective that there wasn't much room for improvement by combining them.
The new study is the latest addition to an "extensive" body of clinical trials demonstrating talk therapy's effectiveness in treating chronic pain and headache, says Russell Portenoy, MD, chair of the department of pain medicine and palliative care at New York's Beth Israel Medical Center.
"Cognitive behavioral therapy [talk therapy] should be offered to a far larger proportion of patients with chronic pain than currently is done," Portenoy, who was not involved in the study, tells WebMD.
He cited several obstacles: Too few therapists trained to provide it, inadequate insurance coverage, a tendency among doctors to focus on medical strategies due to a lack of knowledge about talk therapy, and a lack of reimbursement incentives to offer other treatments.
The study and editorial appear in the Archives of Internal Medicine.
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