The DOI matches its Crossref record, with a small difference in title or year; 102 of the 104 references it cites were found in a registry or an index; none of the 18 sources its claims cite is checked for support yet.
Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis
Open accessAbstract
Importance: Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients. Objective: To evaluate the association of MBTs with pain and opioid dose reduction in a diverse adult population with clinical pain. Data Sources: For this systematic review and meta-analysis, the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases were searched for English-language randomized clinical trials and systematic reviews from date of inception to March 2018. Search logic included (pain OR analgesia OR opioids) AND mind-body therapies. The gray literature, ClinicalTrials.gov, and relevant bibliographies were also searched. Study Selection: Randomized clinical trials that evaluated the use of MBTs for symptom management in adults also prescribed opioids for clinical pain. Data Extraction and Synthesis: Independent reviewers screened citations, extracted data, and assessed risk of bias. Meta-analyses were conducted using standardized mean differences in pain and opioid dose to obtain aggregate estimates of effect size with 95% CIs. Main Outcomes and Measures: The primary outcome was pain intensity. The secondary outcomes were opioid dose, opioid misuse, opioid craving, disability, or function. Results: Of 4212 citations reviewed, 60 reports with 6404 participants were included in the meta-analysis. Overall, MBTs were associated with pain reduction (Cohen d = -0.51; 95% CI, -0.76 to -0.26) and reduced opioid dose (Cohen d = -0.26; 95% CI, -0.44 to -0.08). Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and cognitive behavioral therapy (n = 7) interventions. Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d = -0.70), hypnosis (Cohen d = -0.54), suggestion (Cohen d = -0.68), and cognitive behavioral therapy (Cohen d = -0.43) but not for other MBTs. Although most meditation (n = 4 [80%]), cognitive-behavioral therapy (n = 4 [57%]), and hypnosis (n = 12 [63%]) studies found improved opioid-related outcomes, fewer studies of suggestion, guided imagery, and relaxation reported such improvements. Most MBT studies used active or placebo controls and were judged to be at low risk of bias. Conclusions and Relevance: The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse. Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This systematic review and meta-analysis found that mind-body therapies (MBTs) were associated with moderate reductions in pain and small reductions in opioid dose among adults prescribed opioids for clinical pain. Effects varied by MBT type, with meditation, hypnosis, therapeutic suggestion, and CBT showing significant pain associations, while evidence for opioid-related outcomes was limited by poor opioid dosing reporting.
Key findings
- Across 29 studies (n = 2916; 1679 receiving MBT), MBTs were associated with moderate pain reduction: Cohen d = −0.51 (95% CI, −0.76 to −0.26; P < .001).
- Across 8 studies (n = 435; 250 receiving MBT), MBTs were associated with small opioid dose reduction: Cohen d = −0.26 (95% CI, −0.44 to −0.08; P = .01).
- Significant pain associations were found for meditation (d = −0.70), hypnosis (d = −0.54), therapeutic suggestion (d = −0.68), and CBT (d = −0.43), but not relaxation (d = −0.45; 95% CI, −1.13 to 0.22; P = .19); guided imagery had insufficient pain data for meta-analysis.
- Opioid-related improvements were reported in 4 of 5 meditation studies (80%), 4 of 7 CBT studies (57%), and 12 hypnosis studies (63%), with fewer suggestion, guided imagery, and relaxation studies reporting such improvements; 2 relaxation studies reported significantly worsened opioid dosing outcomes.
Methods
- Systematic review and meta-analysis following PRISMA; searched MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library from inception to March 2018, plus gray literature, ClinicalTrials.gov, and bibliographies.
- Included randomized clinical trials of adults aged ≥18 years prescribed opioids for chronic, acute, procedural, or cancer pain, testing psychologically oriented MBTs (meditation, hypnosis, guided imagery, relaxation, therapeutic suggestion, CBT); excluded acupuncture, spinal manipulation, and yoga/Tai Chi without formal meditation, as well as studies without pain outcomes or with unspecified analgesics.
- Independent screening, data extraction, and Cochrane risk-of-bias assessment; mixed-effects meta-analyses in R Metafor using standardized mean differences, with pain standardized to a 0–10 numeric rating scale and opioid dose converted to morphine equivalents; heterogeneity assessed with Q and I², publication bias with funnel plots and Egger test.
Limitations
- The paper states that high study heterogeneity precluded quantitative conclusions about outcome modifiers such as dose or delivery format, or about durability of treatment effects; outcomes ranged from immediate postintervention to 3 months or longer.
- Approximately one-third of studies had small samples and may have been underpowered; some trials had risk of bias from lack of blinding of participants, personnel, and/or outcome assessors, and lack of intention-to-treat analysis; nearly half were conducted before the revised CONSORT statement in 2001, and funnel plots/Egger statistic indicated some publication bias for meditation and suggestion studies.
- Opioid dosing was insufficiently reported: less than one-fifth of reviewed trials yielded opioid dosing data sufficient for meta-analysis, and many studies were excluded because the analgesic type was unspecified or outcomes for opioid users were not analyzed separately; only 8 studies contributed to the opioid dose meta-analysis, and separate meta-analyses by MBT type for opioid dosing could not be conducted.
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Claims the paper makes
28 Own result · 23 Own method · 13 Not checked yet · 11 Own interpretation · 2 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Meta-analytic results indicated that suggestion had a significant moderate association with pain reduction (Cohen d = -0.68;95% CI, -1.18 to -0.18; P = .008)”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Therapeutic Suggestion Studies
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Two studies 41,80 (29%) reported statistically significant effects of guided imagery on opioid dose.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Association of Guided Imagery With Opioid-Related Outcomes
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Fifteen of the 23 hypnosis studies 26,[29][30][31]33,34,47,[61][62][63][64][65][66][67]69 (65%) reported statistically significant improvements in pain intensity, pain unpleasantness, and/or pain affect.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Hypnosis Studies
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“One study 86 (14%) reported statistically significantly improvements in postoperative mobil-ity.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > CBT Studies
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
In the paper
“nearly approximately half of the trials reviewed were conducted before publication of the revised CONSORT statement in 2001”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Limitations
What the sources say
- Not checked yetcites [95] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the trials reviewed, less than one-fifth yielded opioid dosing data of sufficient detail to be meta-analyzed.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Meta-analytic results indicated that relaxation did not have a significant association with pain reduction (Cohen d = -0.45;95% CI, -1.13 to 0.22; P = .19)”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Relaxation Studies
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Sixty studies with a total of 6404 participants were ultimately included in the review (Figure 1).”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Overview of Studies
plainn = 6,404- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Meta-analytic results indicated that meditation had a significant strong association with pain reduction (Cohen d = -0.70;95% CI, -1.09 to -0.31; P < .001)”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Mindfulness or Meditation Studies
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, MBTs were associated with pain reduction (Cohen d = -0.51;95% CI, -0.76 to -0.26)”
- Also stated in: § Pain-Related Outcome Results · plain
“Overall, MBTs had a significant, moderate association with reduced pain (Cohen d = -0.51;95% CI, -0.76 to -0.27; P < .001)”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Abstract
plaincorrelationaln = 6,404- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Pain-Related Outcome Results · plain
- It may state two separate claims as one. 18
- Probably not a substantial claim. 13
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most of the meditation-based intervention studies focused on treating chronic noncancer pain (eg, low back pain).In contrast, most hypnosis, relaxation, imagery, and suggestion studies focused on treating acute, procedural, or cancer-related pain.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and CBT (n = 7) interventions.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Overview of Studies
plainn = 6,404- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We screened 4212 citations and 603 full-text articles.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Overview of Studies
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The 60 studies focused on various clinical pain targets: procedural pain (n = 39), burn pain (n = 7), cancer pain (n = 5), chronic pain (n = 8), or heterogeneous acute pain conditions (n = 1).”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Overview of Studies
plainn = 39- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Extant evidence from controlled trials suggests that MBTs can improve clinical pain and opioid-related outcomes.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“To help combat the opioid crisis, guidelines encourage practitioners to consider nonopioid pain management options, including mind-body therapies (MBTs).7”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Abstract
What the sources say
- Not checked yetcites [7] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Although opioids are considered to be useful in managing a wide continuum of pain, including acute, procedural, and chronic pain”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Abstract
What the sources say
- Not checked yetcites [6] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Separate meta-analyses by specific MBT type demonstrated significant associations of meditation, hypnosis, CBT, and suggestion with pain outcomes, with the largest effect sizes observed for meditation studies.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Discussion
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Approximately one-third of studies had small samples and therefore may have been underpowered.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Limitations
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies that reported P values but did not report numerical means and SDs for baseline or postintervention pain or opioid use could not be included in the meta-analysis.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Data Extraction and Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“The methods and reporting of this systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines (Figure 1).15”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Literature Search
What the sources say
- Not checked yetcites [15] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Although we performed quantitative meta-analyses on all studies for which we could extract data, the entire body of studies was systematically reviewed in a qualitative manner”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Data Extraction and Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most studies of meditation, hypnosis, and CBT reported significant therapeutic associations with opioid-related outcomes, including opioid dosing, craving, and opioid misuse, whereas comparatively fewer studies of suggestion, imagery, and relaxation reported significant associations with opioidrelated outcomes.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Discussion
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of note, 2 studies 37,74 reported significantly worsened opioid dosing outcomes after relaxation, suggesting the possibility of adverse effects.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Most MBT studies used active or placebo controls and were judged to be at low risk of bias.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The strength of the evidence for the therapeutic effects of MBTs on pain and opioid dose reduction was moderate, although this evidence varied by specific MBT.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Discussion
plaincorrelationaln = 6,000- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most studies used active or placebo controls and had low risk of bias (Figure 3 and eFigures 9-14 in the Supplement), increasing confidence that the reported benefits are not solely the result of nonspecific therapeutic factors.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d = -0.70),hypnosis (Cohen d = -0.54),suggestion (Cohen d = -0.68),and cognitive behavioral therapy (Cohen d = -0.43)but not for other MBTs.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Abstract
plaincorrelationaln = 6,404 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The observed findings on procedural pain are especially notable; if MBTs can reduce procedural pain, they may serve as an important form of primary prevention of long-term opioid use and OUD.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Discussion
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Study heterogeneity was investigated using Baujat plots in conjunction with the Q and I 2 statistics.52,53”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Data Extraction and Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Risk of bias was assessed in Covidence using the Cochrane risk of bias tool by 2 independent reviewers (E.L.G., C.E.B., A.W.H., E.J.R., R.M.A., S.A.G., K.R.F., J.Y., and/or M.F.).”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Data Extraction and Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Abstract
hedgedcorrelationaln = 6,404- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The SDs of the change scores were imputed via Cochrane best practices.51”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Data Extraction and Analysis
What the sources say
- Not checked yetcites [51] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Abstracts and full texts were screened and data extracted independently by 2 reviewers (E.L.G., C.E.B., A.W.H., E.J.R., R.M.A., S.A.G., K.R.F., J.Y., and/or M.F.) via Covidence”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Data Extraction and Analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Few of the studies reviewed measured opioid use, and reviews included patients who were not prescribed opioids.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Abstract
What the sources say
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper relies on this without support.
Mind-body therapies may ameliorate pain and prevent downstream transitions from long-term opioid use to opioid use disorder.
“Mind-body therapies might ameliorate pain and prevent downstream transitions from long-term opioid use to OUD.”
The paper relies on this without support.
Participant self-report of opioid use is unreliable.
“Because participant self-report is unreliable, if possible, data should be extracted from electronic health records and prescription drug monitoring programs.”
The paper relies on this without support.
The National Institutes of Health HEAL initiative has called for studies of mind-body therapies as interventions for pain and opioid use disorder.
“Thus, the National Institutes of Health initiative Helping to End Addiction in the Long Term (HEAL) has called for studies of MBTs as interventions for pain and OUD.”
The paper relies on this without support.
Mind-body therapies that primarily use mental techniques may be more accessible to people whose mobility is compromised by pain or used for pain relief during inpatient procedures when patients are immobilized.
“We elected to focus our review on MBTs that primarily use mental techniques because they may be more accessible to people whose mobility is compromised by pain or used for pain relief during inpatient procedures when patients are immobilized.”
The paper relies on this without support.
Less pain and lower opioid use among patients on opioid therapy for various pain conditions will reduce the opioid crisis.
“Insofar as MBTs are associated with pain relief and opioid use reduction among patients prescribed opioids for a range of pain conditions, MBTs may help alleviate the opioid crisis.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Adjunctive therapies such as acupuncture and mindfulness-based interventions, though supported in broader surgical contexts, have been minimally explored in otoplasty, despite evidence suggesting they may reduce perioperative pain and opioid reliance.10”
From Perioperative Analgesia and Postoperative Nausea and Vomiting Management in Otoplasty: A Systematic Review (2026) · cites this paper as [10]
Experimental — accuracy not yet measured
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- Consistentz = -0.65reported p = .52 · recomputed p = .516
“(z = -0.65,p = .52”
- Consistentz = -0.3reported p = .76 · recomputed p = .764
“(z = -0.30,p = .76”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Abstract
“relaxation (n = 14)”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Relaxation Studies
“Twelve of the 16 relaxation studies 19,24,36,37,39,40,50,[72][73][74][75][76] (75%)”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“Two studies (14%) reported significantly worse opioid-related outcomes”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Association of Relaxation With Opioid-Related Outcomes
Reported 14 · recomputed 12.5
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“Gonzalez et al, 42 2010 -0.11 (-0.70 to -0.48)”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Discussion
Reported -0.11 · recomputed -0.59
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Association of Relaxation With Opioid-Related Outcomes
“with the remainder 24,[35][36][37]40,50,73,74,76 examining single-session relaxation interventions”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Association of Relaxation With Opioid-Related Outcomes
“1 study 40 not reporting that information.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Abstract
“Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and cognitive behavioral therapy (n = 7) interventions.”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Hypnosis Studies
“Fifteen of the 23 hypnosis studies 26,[29][30][31]33,34,47,[61][62][63][64][65][66][67]69 (65%) reported statistically significant improvements”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Abstract
“guided imagery (n = 7)”
§ Mind-Body Therapies for Opioid-Treated Pain A Systematic Review and Meta-analysis > Guided Imagery Studies
“Three of the 9 guided imagery studies 72,78,80 (33%)”
Citations
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Bias in meta-analysis detected by a simple, graphical test
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997) · BMJ · doi:10.1136/bmj.315.7109.629 · Cited by 56,722
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement.
(2009) · PubMed Central · Cited by 44,859
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763
Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series
(2008) · doi:10.1002/9780470712184 · Cited by 25,048
Conducting Meta-Analyses in R with the metafor Package
Viechtbauer, W. (2010) · Journal of Statistical Software · doi:10.18637/jss.v036.i03 · Cited by 20,464
CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
Dowell, D., Haegerich, T. M., & Chou, R. (2016) · JAMA · doi:10.1001/jama.2016.1464 · Cited by 5,161
Outlier and influence diagnostics for meta-analysis
Viechtbauer, W., & Cheung, M. W.-L. (2010) · Research Synthesis Methods · doi:10.1002/jrsm.11 · Cited by 2,949
Moher, D., Schulz, K. F., & Altman, D. G. (2001) · BMC Medical Research Methodology · doi:10.1186/1471-2288-1-2 · Cited by 2,755
Attention regulation and monitoring in meditation
Lutz, A., Slagter, H. A., Dunne, J. D., & Davidson, R. J. (2008) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2008.01.005 · Cited by 2,659
Research works printed but not linked: 1
- 2017, National Academies of Sciences, Engineering, and Medicine. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use
Cited by
Sorted by citations
Psychological Interventions for the Treatment of Chronic Pain in Adults
Driscoll, M. A., Edwards, R. R., Becker, W. C., Kaptchuk, T. J., & Kerns, R. D. (2021) · Psychological Science in the Public Interest · doi:10.1177/15291006211008157 · Cited by 176
Garland, E. L., Hanley, A. W., Nakamura, Y., Barrett, J. W., Baker, A. K., Reese, S. E., Riquino, M. R., Froeliger, B., & Donaldson, G. W. (2022) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2022.0033 · Cited by 176
Self-citationOpioids and Chronic Pain: An Analytic Review of the Clinical Evidence
Nadeau, S. E., Wu, J. K., & Lawhern, R. A. (2021) · Frontiers in Pain Research · doi:10.3389/fpain.2021.721357 · Cited by 121
Pain management in patients with chronic kidney disease and end-stage kidney disease
Roy, P. J., Weltman, M. R., Dember, L. M., Liebschutz, J. M., & Jhamb, M. (2020) · Current Opinion in Nephrology & Hypertension · doi:10.1097/mnh.0000000000000646 · Cited by 95
Mindfulness in migraine: A narrative review
Wells, R. E., Seng, E. K., Edwards, R. R., Victorson, D. E., Pierce, C. R., Rosenberg, L., Napadow, V., & Schuman-Olivier, Z. (2020) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2020.1715212 · Cited by 70
Metadata
- Authors
- Garland, E. L., Brintz, C. E., Hanley, A. W., Roseen, E. J., Atchley, R. M., Gaylord, S. A., Faurot, K. R., Yaffe, J., Fiander, M., & Keefe, F. J.
- Affiliations
- University of Utah (US)
- University of North Carolina at Chapel Hill (US)
- Boston University (US)
- Brigham and Women's Hospital (US)
- Independent consultant, Halifax, Nova Scotia
- Duke University (US)
- Corresponding author
- Garland, Eric L.
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2020-01-01
- Volume
- 180
- Issue
- 1
- Pages
- 91
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC6830441
- OpenAlex
- W2984126577
- Semantic Scholar
- 3f78b224fbf5ff9229a56db2574492b80e347318
- Cited by
- 190
- References
- 104
- Citations by year
- 2026: 18 · 2025: 40 · 2024: 30 · 2023: 28 · 2022: 23 · 2021: 31 · 2020: 19
- FWCI
- 2.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (1f32at009272-01)
- National Institute on Drug Abuse (R34DA040954, R01DA042033)
- National Institute of Nursing Research (R01NR013910)
- National Center for Complementary and Integrative Health (K23AT010487, R61AT009296, UG3AT009790, T32AT003378, U24AT009769)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Keywords
- mind-body interventions, opioid use, pain management, opioid dose reduction, meditation, hypnosis, guided imagery, therapeutic suggestion, cognitive behavioral therapy, relaxation, opioid misuse, chronic pain, acute pain, procedural pain, opioid epidemic, opioid craving, opioid withdrawal symptoms
- MeSH terms
- Analgesics, Opioid, Humans, Cognitive Behavioral Therapy, Meditation, Chronic Pain, Pain Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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