Chronic Pain Management: Moving Beyond Pharmacotherapy

By Roberta Heale, Associate Editor EBN, @robertaheale @EBNursingBMJ

Pain is an essential part of life.  It tells us when and where we’ve sustained an injury.  This acute pain ensures that we seek out and address the problem at hand.  However, some pain continues for much longer than necessary. Pain signals remain active, muscles tense in response, energy is lowered and there are changes in appetite.  People often experience depression, anxiety or anger as a result of living with these ongoing effects.

Treatment of chronic pain can be complex. There are a whole host of medications ranging from opioids to antidepressants to medications addressing neuropathic pain.  Although useful in many cases, medications are not without side effects and there can be negative outcomes, including addiction.  More and more we see alternative therapies being implemented to help in the management of chronic pain such as yoga, massage and acupuncture.  In recent years, attention has turned to treatments that address mental and psychological coping of patients, such as cognitive behavioural therapy (CBT).

One such therapy is acceptance and commitment therapy (ACT).  ACT is a form of therapy that falls into the umbrella of CBT.  ACT is defined by the Association for Contextual Behavioural Science as:

…a unique empirically based psychological intervention that uses acceptance and mindfulness strategies, together with commitment and behaviour change strategies, to increase psychological flexibility. Psychological flexibility means contacting the present moment fully as a conscious human being, and based on what the situation affords, changing or persisting in behaviour in the service of chosen values.1

EBN published a commentary on research that explored the use of ACT for chronic pain management in older adults and the small study showed some promise.

Chronic pain is ubiquitous in health care and in life.  Given this, we, ourselves, need to make a commitment to continue in this trend of exploring alternative, non-pharmacological methods to help our patients cope with and thrive despite chronic pain.  Encouraging them to try CBT or ACT may be a first step.  Conducting research to better understand the complexity of chronic pain and viable treatment options is another essential step.

1.  ACBS. (n.d.)  ACT. Acceptance and Commitment Therapy.  Retrieved from:



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