From the Guidelines
To manage pain effectively, I strongly recommend starting with noninvasive nonpharmacologic approaches, such as cognitive behavioral therapy, mindfulness-based stress reduction, and exercise therapy, as they have been shown to improve pain and function without serious harm. These approaches can be used in conjunction with other therapies to provide comprehensive pain management. According to the CDC clinical practice guideline for prescribing opioids for pain 1, many noninvasive nonpharmacologic approaches can improve pain and function, and high-quality evidence exists that exercise therapy reduces pain and improves function immediately after treatment and that the improvements are sustained for at least 2–6 months.
Some key noninvasive nonpharmacologic therapies that can help with pain management include:
- Cognitive behavioral therapy
- Mindfulness-based stress reduction
- Exercise therapy, such as aerobic, aquatic, or resistance exercises
- Physical therapy
- Manual therapies, such as massage or spinal manipulation
- Mind-body practices, such as yoga or tai chi
- Multidisciplinary rehabilitation
It's essential to note that access and cost can be barriers to these therapies, particularly for patients with low incomes or inadequate insurance 1. However, many of these approaches can be adapted to be low-cost or free, such as walking in public spaces or using public recreation facilities for group exercise. Primary care clinicians can also integrate elements of psychosocial therapies, such as cognitive behavioral therapy, into their practice to support patients in managing their pain 1.
In addition to these noninvasive nonpharmacologic approaches, patient education and self-care can be effective in managing pain, as can skills training and cognitive interventions, such as deep muscle relaxation and biofeedback 1. By combining these approaches and tailoring them to the individual patient's needs, healthcare providers can help patients manage their pain effectively and improve their quality of life.
From the Research
Treatment Options for Pain
- Selective serotonin reuptake inhibitors (SSRIs) have been found to be effective in treating pain, particularly in patients with depression and anxiety 2.
- A systematic review of 19 head-to-head trials found that SSRIs do not differ in their effectiveness for treating anxiety, insomnia, and pain, with moderate evidence to support their use 2.
- Another study found that combining SSRIs with cognitive behavioral therapy (CBT) can be an effective treatment for youth with depression and anxiety, with significant improvements in symptoms by week 4 3.
Medications for Pain Management
- Fluoxetine, an SSRI, has been shown to be safe and effective in the treatment of depression, anxiety, and other conditions, including pain management 4.
- A review of meta-analyses on fluoxetine found that it is effective in reducing depressive symptoms and improving patient outcomes, with a favorable safety profile 4.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs) have also been found to be effective in treating anxiety, obsessive-compulsive, and stress-related disorders, with minimal differences in efficacy and acceptability compared to SSRIs 5.
Combination Therapies for Pain
- Combining medication with CBT has been found to be an effective treatment for adolescent depression, with improved outcomes compared to monotherapy 6.
- A 3-level network meta-analysis found that all SSRIs and SNRIs were effective for multiple symptom domains, including pain, and in patients from all diagnostic categories 5.
- The use of combination therapies, such as SSRIs and CBT, may be beneficial for patients with complex mental health conditions, including pain management 3, 6.