Integrated Behavioral Treatment for Veterans With Co-Morbid Chronic Pain and Hazardous Opioid Use: A Randomized Controlled Pilot Trial

JOURNAL OF PAIN

卷:21

Article

Vowles, Kevin E.¹  Witkiewitz, Katie²  Cusack, Karen J.³  Gilliam, Wesley P.⁴  Cardon, Karen E.³  Bowen, Sarah⁵  Edwards, Karlyn A.¹  McEntee, Mindy L.⁶  Bailey, Robert W.⁷ 

[1] Queens Univ Belfast, Sch Psychol, David Keir Bldg,18-30 Malone Rd, Belfast BT9 5BN, Antrim, North Ireland

[2] Univ New Mexico, Dept Psychol, Albuquerque, NM 87131 USA

[3] New Mexico VA Healthcare Syst, Raymond G Murphy Vet Affairs Med Ctr, Albuquerque, NM USA

[4] Mayo Clin, Pain Rehabil Ctr, Rochester, MN USA

[5] Pacif Univ, Dept Psychol, Forest Grove, OR USA

[6] Arizona State Univ, Coll Hlth Solut, Tempe, AZ USA

[7] Swedish Hlth Syst, Swedish Pain Serv, Seattle, WA USA

关键词: Chronic pain;    opioids;    veterans;    integrated treatment;    acceptance and commitment therapy;    mindfulness-based relapse prevention;   

DOI  :  10.1016/j.jpain.2019.11.007

来源: Elsevier

【 摘 要 】

Opioid prescription in the treatment of chronic pain is frequent and carries a risk of increased morbidity and mortality in a clinically significant number of patients, particularly those who are using opioids in a hazardous manner. Few treatment options are available that target both pain-related interference and hazardous opioid use among patients with chronic pain. In military Veterans, this issue is of particular importance as numerous reports indicate continued high rates of opioid prescription for chronic pain, as well as significant opioid-related problems. The overall aim of the present study was to determine the feasibility of an integrated psychosocial treatment in Veterans with chronic pain, who also have evidence of hazardous opioid use. To examine this aim, a random design was used to assess the feasibility and initial efficacy of integrating 2 empirically supported interventions: Acceptance and Commitment Therapy for chronic pain and Mindfulness Based Relapse Prevention for opioid misuse. Half of participants were randomized to the integrated treatment group and all participants received usual care through a Veteran's Administration co-occurring disorders medical clinic to treat chronic pain and opioid misuse. In total, 37 participants were randomized and included in intent-to-treat analyses and 32 individuals were included in per protocol analyses with 6-month follow-up serving as the primary study endpoint. Feasibility indicators included recruitment, retention, and treatment completion rates. Recruitment fell short of targeted enrollment, although retention and completion were excellent. Primary outcome measures were opioid misuse, pain interference, and pain behavior. Simultaneous multiple regression analyses controlled for pain duration, baseline opioid dose, and baseline value for outcome measures. Results of both the intent-to-treat and per protocol indicated a significant effect in favor of the integrated intervention for opioid misuse, pain interference, and pain behavior. Results support the feasibility of providing an integrated treatment for both opioid risk and pain interference. Perspective: Opioid misuse occurs in some opioid-prescribed individuals with chronic pain. Few treatment options exist that target both pain interference and opioid misuse. This study examined feasibility and initial efficacy of an integrated behavioral treatment for Veterans. Feasibility was supported, except recruitment. Efficacy was supported compared to usual care. (C) 2019 by United States Association for the Study of Pain, Inc.

【 授权许可】

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