This paper reviews the evidence for mind-body therapies (eg, relaxation, meditation, imagery, cognitive-behavioral therapy) in the treatment of pain-related medical conditions and suggests directions for future research in these areas. Based on evidence from randomized controlled trials and in many cases, systematic reviews of the literature, the following recommendations can be made: 1) multi-component mind-body approaches that include some combination of stress management, coping skills training, cognitive restructuring and relaxation therapy may be an appropriate adjunctive treatment for chronic low back pain; 2) multimodal mind-body approaches such as cognitive-behavioral therapy, particularly when combined with an educational/informational component, can be an effective adjunct in the management of rheumatoid and osteoarthritis; 3) relaxation and thermal biofeedback may be considered as a treatment for recurrent migraine while relaxation and muscle biofeedback can be an effective adjunct or stand alone therapy for recurrent tension headache; 4) an array of mind-body therapies (eg, imagery, hypnosis, relaxation) when employed pre-surgically, can improve recovery time and reduce pain following surgical procedures; 5) mind-body approaches may be considered as adjunctive therapies to help ameliorate pain during invasive medical procedures.
The NIH's National Center for Complementary and Alternative Medicine (NCCAM) defines mind–body medicine as “behavioral, psychologic, social and spiritual approaches to medicine not commonly used.” Mind–body therapies (MBTs) include meditation, relaxation, imagery, hypnosis, and biofeedback. However, there has been considerable controversy in the field regarding which of the mind–body modalities should be considered “alternative.” Some researchers within the mainstream academic and clinical disciplines of behavioral medicine and health psychology argue that the interventions they have spent, in many cases, decades researching in rigorous, carefully controlled studies should not be lumped together with less proven alternative therapies. 1 While I agree in part with this critique and would say that most of the mind–body interventions have been used as complements to rather than substitutes for (ie, alternative to) conventional medical interventions, the bulk of these modalities have largely remained at the margins of medical practice. For example, research suggests that the biomedical model of health and illness, and not the biopsychosocial one remains the dominant paradigm taught in medical schools today. 2 Following Eisenberg's original definition of “unconventional” medicine as those practices not commonly taught in U.S. medical schools nor practiced in U.S. hospitals, 3 it can be argued that the majority of MBTs, while possibly gaining in credibility and acceptance, are not practiced or incorporated as part of standard medical care and training today. 4
Despite this lack of acceptance, these approaches are of considerable interest to patients. MBTs in fact, constitute a major portion of the overall use of complementary and alternative medicine (CAM) by the public. In 1997, 5 relaxation techniques, imagery, biofeedback, and hypnosis, taken together, were used by 23% of the adult U.S. population. Of these, 16.3% reported using relaxation strategies, the second most frequently used of all CAM therapies.
In this paper, evidence is reviewed for an array of MBTs (including more conventional behavioral medicine and psychosocial approaches) for the following pain-related medical conditions: headache disorders, low back pain, rheumatologic conditions (osteoarthritis, rheumatoid arthritis, fibromyalgia), and chronic pain in general. In addition, the paper summarizes the evidence examining MBTs for post-surgical pain, treatment and disease-related pain symptoms in cancer, and pain during labor and delivery.
From the California Pacific Medical Center Research Institute, San Francisco, California.
Received for publication October 16, 2002; accepted October 16, 2002.
Reprints: John A. Astin, PhD, P.O. Box 426, Santa Cruz, CA 95061 (e-mail: firstname.lastname@example.org).