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NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches Into the Treatment of Chronic Pain and Insomnia

JAMA. 1996;276(4):313-318.

Abstract
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 medicine, psychiatry, psychology, public health, nursing, and epidemiology. In addition, 23 experts in behavioral medicine, pain medicine, sleep medicine, psychiatry, nursing, psychology, neurology, and behavioral and neurosciences presented data to the panel and a conference audience of 528 during a 11/2-day public session. Questions and statements from conference attendees were considered during the open session. Closed 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 references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience.

Assessment 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 statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference.

Conclusions.
—A number of well-defined behavioral and relaxation interventions now exist and are effective in the treatment of chronic pain and insomnia. The panel found strong evidence for the use of relaxation techniques in reducing chronic pain in a variety of medical conditions as well as strong evidence for the use of hypnosis in alleviating pain associated with cancer. The evidence was moderate for the effectiveness of cognitive-behavioral techniques and biofeedback in relieving chronic pain. Regarding insomnia, behavioral techniques, particularly relaxation and biofeedback, produce improvements in some aspects of sleep, but it is questionable whether the magnitude of the improvement in sleep onset and total sleep time are clinically significant.

Footnotes
NIH Technology Assessment Conferences and Workshops are convened to evaluate available scientific information related to a biomedical technology. The resultant NIH Technology Assessment Statements and published reports are intended to advance understanding of the technology or issue in question and to be useful to health professionals and the public. This statement is an independent report of the panel and is not a policy statement of the NIH or the federal government.

Preparation and distribution of this statement is the responsibility of the Office of Medical Applications of Research of the National Institutes of Health. Free copies of this statement with bibliography as well as all other available NIH Technology Assessment Statements and NIH Consensus Statements may be obtained from NIH Consensus Program Information Center, PO Box 2577, Kensington, MD 20891, or call toll-free (888) NIH-CONSENSUS (644-2667). Full-text versions of all these statements are also available online through the Internet using Gopher (gopher:// gopher.nih.gov/Health and Clinical Information), file transfer protocol (ftp://public.nlm.nih.gov/hstat/ nihcdcs), or the World Wide Web (http://text.nlm.nih. gov/nih/nih.html).

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