INTEGRATION OF BEHAVIORAL AND RELAXATION APPROACHES INTO THE TREATMENT OF CHRONIC PAIN AND INSOMNIA

Objective.-To provide physicians with a responsible assessment of the integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia. Participants.-A nonfederal, nonadvocate , 12-member panel representing the fields of family medicine, social m edicine, psychiatry, psychology, public health, nursing, and epidemiol ogy. In addition, 23 experts in behavioral medicine, pain medicine, sl eep medicine, psychiatry, nursing, psychology, neurology, and behavior al and neurosciences presented data to the panel and a conference audi ence of 528 during a 1 1/2-day public session. Questions and statement s from conference attendees were considered during the open session. C losed deliberations by the panel occurred during the remainder of the second day and the morning of the third day. Evidence.-The literature was searched through MEDLINE, and an extensive bibliography of referen ces was provided to the panel and the conference audience. Experts pre pared abstracts with relevant citations from the literature. Scientifi c evidence was given precedence over clinical anecdotal experience. As sessment Process.-The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statem ent that was read in its entirety and circulated to the experts and th e audience for comment. Thereafter, the panel resolved conflicting rec ommendations and released a revised statement at the end of the confer ence. The panel finalized the revisions within a few weeks after the c onference. Conclusions.-A number of well-defined behavioral and relaxa tion interventions now exist and are effective in the treatment of chr onic pain and insomnia. The panel found strong evidence for the use of relaxation techniques in reducing chronic pain in a variety of medica l conditions as well as strong evidence for the use of hypnosis in all eviating pain associated with cancer. The evidence was moderate for th e effectiveness of cognitive-behavioral techniques and biofeedback in relieving chronic pain. Regarding insomnia, behavioral techniques, par ticularly relaxation and biofeedback, produce improvements in some asp ects of sleep, but it is questionable whether the magnitude of the imp rovement in sleep onset and total sleep time are clinically significan t.