For people in pain, a prescription for pain medication is both expected and welcome—or at least that’s how it’s been in the past. Today, however, the cost of the opioid crisis, both economically and in the lives lost, is pushing health care providers and their patients to think differently about how pain medications are prescribed and taken.
Massage Therapy Journal sat down with Robert Kerns, Ph.D., professor of psychiatry, neurology and psychology at Yale University and currently the program director of the National Institutes of Health Department of Defense–Department of Veterans Affairs Pain Management Collaboratory, to talk about addressing the opioid epidemic with massage therapy.
What excites you most about the research being done in the massage therapy profession?
I am particularly enthusiastic about research that addresses key scientific knowledge and clinical practice gaps such as questions on nonpharmacological approaches to chronic musculoskeletal pain management. Massage can be considered a passive treatment approach that requires outpatient encounters with providers, so barriers to access, reimbursement and payment, and integration with other approaches are important questions that need to be explored.
Where do you think research has made the biggest impact in the massage therapy profession?
The availability of high-quality research is essential in supporting the credibility of this approach for a broad array of painful conditions. This has almost certainly contributed to the establishment of billing codes for these services and increasing interest on the part of health care organizations to offer massage therapy services for pain management.
What role can massage therapy play in an integrative approach to pain management?
Massage therapy is already recognized as one of a few nonpharmacological approaches with a strong enough evidence base to encourage routine availability of this approach as a potential component of an integrated, patient-centered, evidence-based, multimodal and interdisciplinary plan of care for persons with chronic musculoskeletal pain. Determination of optimal timing of this approach (e.g., first or early line treatment for all persons, primarily appropriate when other modalities have failed) is particularly important.
Is there anything about the pain veterans experience that is unique or different from other people’s pain?
Veterans are known to have a higher prevalence of chronic pain, but perhaps not high-impact chronic pain. Still, understanding factors that contribute to this higher prevalence are only beginning to be uncovered. It is presumed that factors related to military service may be important, but data supporting this assumption are not compelling. Higher rates of medical—and particularly mental health and substance use disorder comorbidities—are also putative risk factors that require additional exploration, as well as other sociodemographic factors like education, social support and income.
As a clinical psychologist, how does mental health intersect with pain and pain management?
There is considerable evidence of the high co-prevalence of mental health and substance use disorders among people with chronic pain. There is also ample evidence that pain moderates outcomes for mental health treatment, including both pharmacological and nonpharmacological approaches. Mental health providers need to be educated and trained to conduct routine pain assessments and to integrate a plan for pain care regardless of the primary mental health condition.