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Helping people with chronic pain to reduce their reliance on painkillers

At least one in five people are affected by chronic pain and the numbers are increasing. Analgesic medication (painkillers) can help people maintain their everyday life, but some people develop problems with their use, including becoming addicted. James Elander, Professor of Health Psychology at the University of Derby, explores how people affected by chronic pain can be helped by compassionate mind training.

By Professor James Elander - 6 July 2020

Problem use of painkillers can be classified in different ways. For example, painkiller ‘abuse’ generally refers to when people take painkillers for reasons other than to control pain, such as to get high or relax.

Painkiller ‘misuse’ generally refers to when people take painkillers to control pain, but don’t use them as directed, such as taking them for longer or in higher doses than recommended. The concepts of ‘abuse’ and ‘misuse’ are problematic, however, because they depend on medical, legal and cultural standards that can vary from place to place or from time to time.

Painkiller dependence

The concept of painkiller ‘dependence’ is more helpful because it can be assessed more reliably and can be measured on a continuum.

A good way to measure painkiller dependence is with the Leeds Dependence Questionnaire, which asks 10 questions about how much time people spend people thinking about painkillers and how they arrange their lives around taking painkillers.

Dependence develops in a process, so it is useful to identify people at an early stage and target them for interventions to help them reduce or control their dependence and their use of painkillers.

Painkiller addiction is often in the news because of the ‘opioid epidemic’ that is causing thousands of deaths in the USA and other countries. The number of people affected by painkiller addiction is reflected in the frequency with which well-known people are involved. These include the musician Prince, and television presenter Ant McPartlin, as well as those featured in Ross Kemp’s recent documentary which investigated people who were living with painkiller addiction.

Can compassionate mind training help with painkiller dependency?

Previous research at the University of Derby examined factors that increase the risk of painkiller dependence[1]Myself and a team of researchers have also examined international similarities and differences between countries in rates of analgesic misuse and risks for painkiller addiction[2]. painkiller addiction.

The latest research, conducted by University of Derby PhD student Mayoor Dhokia and supervised by myself, along with Derby psychology academics Keith Clements and Paul Gilbert,has shown promising results for a type of online support to help people with chronic pain reduce their reliance on painkillers.

In the age of social distancing, more and more psychological interventions are delivered online and there is a demand for supportive online interventions for people with chronic pain conditions who may not be able to attend hospital and other clinics to get advice and support.

Compassionate Mind Training (CMT) is a type of psychological intervention developed by Professor Paul Gilbert that helps people with emotional and behavioural problems to manage their lives better by learning to be more compassionate and less critical about themselves, and to see their own problems in different ways. CMT has been adapted for different types of problems and is increasingly adapted for online delivery, but this was the first such intervention for people with chronic pain and problems with painkiller use.

Mayoor Dhokia designed materials and exercises that were based on CMT but adapted for problems with chronic pain and painkillers, and then set up a website where people were guided through the exercises in a structured way over a three-week programme.

The intervention exercises

The intervention involved daily exercises designed to take around 10-15 minutes per day. These involved a series of videos and compassion-focused imagery exercises, for example imagining oneself at one’s compassionate best, the qualities that one would endorse, and how to enact those on a regular basis.

After these five videos, participants engaged with a CMT exercise video, which incorporated the full range of CMT exercises from the five psycho-educational videos. The overall goal was to replace self-critical thoughts with self-reassuring thoughts.

Immediately after watching the exercise video, participants were redirected to a web page to engage with the CMT intervention software. This was designed to increase awareness of self-critical thoughts and develop effective responses to those thoughts using self-compassion skills learned from the videos.

After all exercises, participants were redirected to their personal online pain diary, which was an optional “e-Journal” in which participants could enter private thoughts. Any self-critical thoughts recorded in the pain diary could later be added to the participant’s personal database.

Study findings

This intervention helped people to feel differently about their pain and their analgesic use, and helped them make more reflective, less impulsive decisions about taking painkillers. As a team, we conducted a randomised-controlled trial in which 73 people with chronic pain took part, half of them using CMT and half acting as a control group and listening to relaxing music.

In key findings, the trial showed that compassionate mind training helped people to reduce their daily use of painkillers and their dependence on painkillers compared with the relaxation music group.

These results were recently published in the Journal Psychology of Addictive Behaviours and we hope to use the initial findings as the basis for grant applications for larger trials to develop and evaluate more online support for people with chronic pain.

The study shows how versatile compassionate mind training is, and how it can be adapted to address different specific problems.

For painkiller dependence, the findings of the study are just the first step in what needs to be a larger programme, but they suggest people can be helped by online exercises and materials based on compassionate mind training.

We hope to use these findings to justify a larger trial with more people and a longer follow-up period to investigate how CMT helps people to change their attitudes, beliefs and behaviour as well as their painkiller use.

For more information, read the full research paper.

[1] Elander, J., Duarte, J., Maratos, F.A. & Gilbert, P. (2014). Predictors of painkiller dependence among people with pain in the general population. Pain Medicine, 15 (4), 613-624. DOI: 10.1111/pme.12263

[2] Said, O., Elander, J. & Maratos, F. (2019). An international study of analgesic dependence among people with pain in the general population. Substance Use and Misuse, 54, 8, 1319-1331. Published online 26-March-2019 DOI: 10.1080/10826084.2019.1577457

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About the author

Professor James Elander
Professor of Health Psychology

James Elander is an HCPC-registered health psychologist who conducts research on chronic illnesses including haemophilia, sickle cell disease, end-stage renal disease, spinal pain, and dysmenorrhea. He also has a longstanding interest in the psychology of learning and teaching, especially student writing.

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