Friday, August 7, 2020

Targeted Behavioral Pain Management May Improve Chronic Pain in Patients With Substance Use Disorder

Behavioral pain management techniques that focus on the interplay between chronic pain and the potential for substance abuse may improve pain tolerance and lower pain intensity in patients who have substance use disorder (SUD), suggests a study in JAMA Psychiatry.

Mark A. Ilgen, Ph.D., of the VA Center for Clinical Management Research in Ann Arbor, Mich., and colleagues compared pain tolerance and intensity of 470 adults over 12 months. All patients were in treatment for SUD and had chronic pain. Patients were randomized to receive either the Improving Pain During Addiction Treatment (ImPAT) intervention or supportive psychoeducation control in addition to treatment as usual for their SUD and chronic pain. ImPAT emphasizes the link between pain and poor functioning and the risk of using substances to cope with pain. Treatment using this approach focuses on conceptualizing and responding to pain with the goal of also preventing relapses to substance use. Although supportive psychoeducation also focuses on ways of responding to pain, it is less specific than ImPAT and does not emphasize ways to avoid misusing substances to cope with pain.

Patients in both groups attended eight one-hour group sessions over four weeks. The researchers measured the patients’ pain using the first item of the Numeric Rating Scale of Pain Intensity, which measures pain on a scale of 0 to 11. They also measured the patients’ pain tolerance using the ischemic pain task, which involves doing handgrip exercises while blood flow to the arm is restricted by a blood pressure cuff.

At 12 months, men in the ImPAT group experienced a median increase of 0.25 points in pain tolerance but a median increase of 0.11 points in pain intensity compared with their peers in the supportive psychoeducation group. In the same time frame, women in the ImPAT group experienced a median decrease of 0.22 points in pain intensity but a median decrease of 0.07 points in pain tolerance compared with their peers in the psychoeducation group. The ImPAT intervention did not appear to affect the risk of relapsing to substance use, as relapse rates were similar in both groups.

“These findings highlight the potential benefits of [the ImPAT] approach on pain-related outcomes for SUD treatment settings and raise the possibility that integrating behavioral pain management and SUD services could be particularly beneficial for the large number of individuals with co-occurring pain and SUDs,” the researchers wrote. “However, the effect sizes were small, and we did not detect an effect of the ImPAT condition on SUD outcomes, highlighting the need for future work to continue to look at ways to enhance integrated pain and SUD treatment effects to improve clinical outcomes in the high-risk group of patients with both pain and SUDs.”

For related information, see the American Journal of Psychiatry article “U.S. Adults With Pain, a Group Increasingly Vulnerable to Nonmedical Cannabis Use and Cannabis Use Disorder: 2001–2002 and 2012–2013.”

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