Thinking our way to better treatments of chronic pain.

摘要

PAIN IS COMMON IN THE ADULT POPULATION, with 20% to 40% of adults reporting chronic pain. In primary care settings, up to 20% of visits generate an opioid prescription, and in the United States overall, 4 million adults are prescribed a long-acting opioid each year. As these prescriptions have increased, so have consequences, such as impairment, overdose, diversion, and dependence. Despite being the backbone of therapy for chronic non-malignant pain, there is little evidence that long-term opioid use is efficacious in reducing pain, much less in restoring function, the true goal of treatment. Indeed, the most prominent guidelines in the area feature evidence that is not high quality. Despite the fact that patients are often treated with opioids for chronic pain indefinitely, the few randomized studies that support this treatment were only a few months in duration. For these reasons, non-opioid-based alternatives to chronic pain management are desperately needed. Fortunately, in this issue of the Archives, McBeth et al make an important contribution by demonstrating that cognitive behavioral therapy (CBT) and exercise, either alone or in combination, are superior to usual management of chronic widespread pain, a subset of chronic nonmalig-nant pain.