Abstract
Pain is both an alarming and useful signal that demonstrates that certain malfunctions are occurring and serves as a call for action. However, the subjective sensations experienced by different patients may vary greatly – some easily endure pain, while others feel the same pain acutely. Chronic pain is a syndrome that significantly diminishes life quality and life satisfaction. Research has shown that the leading cause of chronic pain is pathological disturbances in perception and similar mental processes. They can be triggered by injuries and operations, heart attacks and strokes, or significant stressful situations. Nowadays, several treatment methods gain substantial recognition for chronic pain treatment – medical cannabis, hybrid emotion-focused treatment, and acetaminophen are among them. Each of the methods possesses qualities that the others may lack, but also certain drawbacks.
Introduction
Chronic pain syndrome is an independent disease that significantly deteriorates the quality of a patient’s life. The syndrome does not fulfill a protective function and does not bear any biological expediency. On the contrary, chronic pain leads to maladaptation, to an abnormal perception of pain and non-pain impulses, and is accompanied by various disorders of the central nervous system. It should be noted that chronic pain results in considerable discomfort, and often acute suffering for patients. Modern medical knowledge, seemingly, does not provide a clear understanding of the mechanisms of chronic pain, which leads to a lack of clear standards for the management of patients that suffer from it. Nevertheless, new treatment approaches emerge, promising to alleviate the suffering that chronic pain patients undergo.
Main body
The popularity of medical cannabis (MC) for chronic pain treatment is increasing progressively, and more and more researchers are involved in investigating its virtues. A study conducted by Bellnier et al. on efficacy, safety, and costs of treating chronic pain with MC aimed at comparing life quality and pain scores at the beginning and three-month after MC therapy (Bellnier et al., 2018). European Quality of Life 5 Dimension (EQ-5D) Questionnaire and Pain Quality Assessment Scale (PQAS) were used for the evaluation in which 29 subjects participated (Bellnier et al., 2018). The participants used only non-smokable dosage forms of MC (Bellnier et al., 2018). It should be noted that the number of participants, and thus sample size, seems to limit the potential for overarching judgment of the results and their universality.
The study showed positive effects that MC has in chronic pain treatment. Both EQ-5D and PQAS scores improved after the three-month therapy, demonstrating enhanced life quality, diminished pain, and even lesser opioid usage (Bellnier et al., 2018). In this regard, the researchers (Bellnier et al., 2018) state that “preclinical evidence suggests cannabinoids increase the analgesic effect of opioids, thus requiring a lower dose to achieve relief” (p. 113). Despite the study’s limitations, such as sample size, its retrospective nature, and the absence of full awareness of patients that leads to the lack of blinding, it demonstrates consistency with other investigations. On the whole, Bellnier et al. showed that MC is sufficiently effective in neuropathic pain alleviation.
Chronic pain often appears to result in depression and anxiety, making the necessity for a treatment that could aim these supplementary symptoms as well, especially poignant. Managing chronic pain using hybrid emotion-focused treatment is the center of the research in which 115 chronic patients participated during January 2016 and September 2018 in two cities in Sweden (Boersma et al., 2019). The study compares the efficacy of cognitive-behavioral therapy (CBT) and hybrid emotion-focused treatment with a greater focus on the latter. Boersma et al. (2019) state that “the hybrid treatment (n=58, 10-16 sessions) integrates exposure in vivo for chronic pain based on the fear-avoidance model with an emotion-regulation approach informed by procedures in Dialectical Behavior Therapy” (p. 1708). In this way, the treatment stems from the reasoning that chronic pain and emotional issues are both based on similar cognitive operations. The division between the two options was randomized, and the number of participants in each was almost equal.
The research shows that hybrid emotion-focused treatment could be considered an effective treatment option for chronic pain patients with psychological complications. The article dedicated to the study shows that it is extensive, prolonged in time, and, seemingly, has an adequate sample size. Regarding the limitations of the research described in the article, its authors note that, for instance, the methods used for patient selection limit its generalization potential (Boersma et al., 2019). Overall, the study revolves around the demonstration of how emotion regulation correlates with pain coping.
Acetaminophen is one of the most common recommendations for treating all types of pain. Moreover, the drug is advocated by WHO as the first-line pain treatment agent (Ennis et. al, 2015). “Acetaminophen for Chronic Pain: A Systematic Review on Efficacy ” is an article that systematically investigates acetaminophen’s effectiveness and reasons for its widespread usage based on already conducted researches. The article’s authors (Ennis et. al, 2015) notice that “the primary strength of this study is the multiple broad search strategies designed to include original data on either chronic pain or conditions associated with chronic pain” (p. 186). Hence, the conclusion that the authors draw on acetaminophen’s somewhat limited effectiveness and dubiousness of arguments for its use seem relatively reliable. The lack of research on acetaminophen’s long-term effects on chronic pain is another discouraging argument given by the authors (Ennis et al., 2015). Overall, the article in question represents a comprehensive analysis of the perceived effectiveness of acetaminophen and persuades against it.
Conclusion
The problem of chronic pain has become widely investigated because of the high prevalence and the variety of forms in which it manifests. Its significance is further emphasized by the creation of specialized pain centers and clinics in several countries to treat patients with chronic pain syndromes. Depending on the nature of the psychopathological symptoms, severity, and patients’ motivation, various techniques may be used to alleviate chronic pain, varying from MC to hybrid emotion-focused treatment.
References
- Bellnier, T., Brown, G. W., & Ortega, T. R. (2018). Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis. Mental Health Clinician, 8(3), 110–115.
- Boersma, K., Södermark, M., Hesser, H., Flink, I. K., Gerdle, B., & Linton, S. J. (2019). Efficacy of a transdiagnostic emotion–focused exposure treatment for chronic pain patients with comorbid anxiety and depression. PAIN, 160(8), 1708–1718.
- Ennis, Z. N., Dideriksen, D., Vaegter, H. B., Handberg, G., & Pottegård, A. (2015). Acetaminophen for chronic pain: A systematic review on efficacy. Basic & Clinical Pharmacology & Toxicology, 118(3), 184–189.