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Date: October 18, 1995 For Release: Immediate Contact: NIH (301) 496-4819
Millions of Americans are afflicted with chronic pain and insomnia--two conditions with psychosocial and behavioral characteristics. The suffering and disability from these disorders result in a heavy burden for individual patients, their families, and their communities as well as the loss of billions of dollars to the Nation as a consequence of disability and lost productivity.
Conventional treatments for these disorders have focused on medical interventions such as drugs and surgery, which have had limited success. However, incorporation of behavioral and relaxation techniques have been used to enhance conventional therapy.
"Integrating behavioral and relaxation therapies with conventional medical treatment is imperative for successfully managing these conditions. Matching the therapy to the illness and the patient must be our goal," said panel chair Julius Richmond, M.D., the John D. MacArthur Professor of Health Policy Analysis Emeritus at Harvard Medical School.
The 12-member panel found strong evidence that relaxation approaches are effective in treating a variety of chronic pain conditions such as low back pain, arthritis, and headache. Relaxation techniques involve the practice of two basic components: a repetitive focus on a word, sound, prayer, phrase, or muscular activity, and neither fighting nor focusing on intruding thoughts. When done properly, relaxation therapy can lower one's breathing rate, heart rate, and blood pressure.
The group stated that there was evidence that hypnosis is effective in alleviating chronic pain associated with various cancers. Hypnosis can als o be a part of the treatment program for irritable bowel syndrome, inflammatory conditions of the mouth, temporomandibular disorders, and tension headaches, t he panel concluded.
After examining the data on biofeedback techniques, the panel determined that this therapy was effective in relieving chronic pain, citing tension headache in particular. Biofeedback is a process that provides auditory, sensory, or visual information to a person, enabling that person to gain voluntary control over a physiological response.
Cognitive/behavioral techniques, which teach individuals to alter patterns of negative thoughts are also effective therapies, primarily in the treatment of low back pain and arthritis, the panel said.
The panel concluded that the relaxation and biofeedback techniques used for chronic pain were effective in alleviating some types of insomnia. However, they determined the most effective treatments for insomnia include sleep restriction, stimulus control (developing specific association between the bedroom and sleep), or a combination of a variety of sleep disorder therapies.
While behavioral and relaxation techniques have increasingly been used in conjunction with conventional medical care, the panel identified a number of barriers that to date have limited wider acceptance of these techniques.
One of these barriers has been the emphasis on treating chronic pain and insomnia strictly as medical conditions without considering their psychosocial components. The panel recommended that health care practitioners adopt a biopsychosocial approach to disease that incorporates the patient's social and ethical experience of disease and expands the potential treatments available.
A second barrier is patient acceptance and willingness to participate in behavioral techniques, which can be time consuming and often must be practiced at home. The panel recommended patient education to promote increased understanding of the importance and potential health benefits and willingness to participate in these interventions.
The reluctance of insurance companies and other third party payers to reimburse for behavioral and relaxation interventions was identified by the panel as another barrier to wider use of these treatments. The panel advocated for reimbursement of psychosocial therapy for chronic pain and insomnia as part of comprehensive medical services at rat es comparable to standard medical care. Additionally, provisions for these treatments should be included in expanding managed care programs. The panel said that decisions will need to be made to identify practitioners best qualified to provide psychosocial interventions in the most cost effective manner.
The panel concluded that a number of well-defined behavioral and relaxation interventions are now available, some of which are commonly used to treat chronic pain and insomnia. However, data are insufficient to conclude that one technique is more effective than another for a given condition. For any individual patient, however, one approach may be more appropriate than another.
The panel made their recommendations at the conclusion of the 3-day NIH Technology Assessment Conference on the Integration of Behavioral and Relaxation Approaches Into the Treatment of Chronic Pain and Insomnia. The conference was sponsored by the NIH Office of Alternative Medicine and NIH Office of Medical Applications of Research.
Radio actualities from this conference will be available starting at 5 p.m. EDT on Wednesday, October 18, 1995 by calling the NIH Radio News Service at 1-800-MED-DIAL.
Bill Hall National Institutes of Health Bethesda, MD, USA Phone: (301) 496-4819 Fax: (301) 402-0420 E-mail: billhall@nih.gov