An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain

Barry, Declan T.; Beitel, Mark; Cutter, Christopher J.; Fiellin, David A.; Kerns, Robert D.; Moore, Brent A.; Oberleitner, Lindsay; Madden, Lynn M.; Liong, Christopher; Ginn, Joel; Schottenfeld, Richard S.

doi:10.1016/j.drugalcdep.2018.10.015

Cited by 65 publications

(49 citation statements)

References 51 publications

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“…Behavioral intervention approaches developed specifically for comorbid AUD and chronic pain are also lacking. However, there are promising preliminary data to support the efficacy of cognitive–behavioral treatment (CBT) for comorbid pain and substance use disorders (Barry et al, ; Morasco et al, ), although CBT has been shown to be modestly effective for AUD (Magill and Ray, ). Mindfulness‐ and acceptance‐based interventions are effective for pain (McCracken and Vowles, ) and AUD (Bowen et al, ), and may be effective for the treatment of comorbid pain and AUD, particularly given recent evidence of effectiveness in the treatment of comorbid pain and OUD (Garland et al, ).…”

Section: Treatment Implications and Treatments Targeting Comorbid Chrmentioning

confidence: 99%

Alcohol and Pain: A Translational Review of Preclinical and Clinical Findings to Inform Future Treatment Strategies

Edwards

Vendruscolo

Gilpin

et al. 2020

Alcoholism Clin & Exp Res

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Alcohol use disorder (AUD) and chronic pain are enduring and devastating conditions that share an intersecting epidemiology and neurobiology. Chronic alcohol use itself can produce a characteristic painful neuropathy, while the regular analgesic use of alcohol in the context of nociceptive sensitization and heightened affective pain sensitivity may promote negative reinforcement mechanisms that underlie AUD maintenance and progression. The goal of this review was to provide a broad translational framework that communicates research findings spanning preclinical and clinical studies, including a review of genetic, molecular, behavioral, and social mechanisms that facilitate interactions between persistent pain and alcohol use. We also consider recent evidence that will shape future investigations into novel treatment mechanisms for pain in individuals suffering from AUD.

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Section: Treatment Implications and Treatments Targeting Comorbid Chrmentioning

confidence: 99%

Alcohol and Pain: A Translational Review of Preclinical and Clinical Findings to Inform Future Treatment Strategies

Edwards

Vendruscolo

Gilpin

et al. 2020

Alcoholism Clin & Exp Res

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“…While brief motivational interviewing was not found to be superior to other interventions for reduction of opioid usage, previous studies have investigated the effectiveness of other behavioral interventions, such as cognitive behavioral therapy (CBT), on the reduction of opioid usage. CBT has been shown to increase abstinence from drugs in those addicted to prescription opioids [ 40 ] and to be superior to methadone drug counseling at increasing abstinence from non-prescription opioids [ 41 ]. These results, while promising, are in contrast to our results.…”

Section: Discussionmentioning

confidence: 99%

Low theoretical fidelity hinders the research on health coaching for opioid reduction: A systematic review of randomized controlled trials

et al. 2020

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Purpose To systematically review the literature in order to evaluate the effects of health coaching on patients’ reduction of opioid usage and opioid discontinuation. In addition, this systematic review investigated the effects of health coaching on pain intensity, physical function, and quality of life. Methods Four electronic databases (PubMed, Embase, Scopus, and PsychINFO) were searched from inception to December 2019. Randomized controlled trials assessing the effects of health coaching interventions in adult patients currently using opioids were included. We considered trials if they included any of the four defined key constructs of health coaching adopted in this review: motivational interviewing, positive psychology, the transtheoretical model, and self-determination theory Independent reviewers screened and selected studies, extracted data, and assessed risk of bias using Revised Cochrane risk-of-bias tool for randomized trials (RoB2) and quality of evidence using Grading, Recommendation, Assessment, Development, and Evaluation (GRADE). The review is registered in the International Prospective Register of Systematic Reviews (PROSPERO) databased as CRD42019136201. It was not possible to perform a meta-analysis due to heterogeneity between included trials. Results Eleven studies met our inclusion criteria (n = 4,516 participants). No study assessed all four constructs of health coaching. All eleven studies utilized only one of the constructs, brief motivational interviewing. Thus, we reported our results in terms of motivational interviewing. There is conflicting and very low quality of evidence that brief motivational interviewing may or may not be more effective than education to reduce opioid usage. There is very low quality of evidence that brief motivational interviewing is more effective than educational monthly diaries to reduce opioid use. There is very low to low quality of evidence that brief motivational interviewing is not more effective than no behavioral intervention to reduce opioid use at 6 months follow-up, treatment as usual (TAU) to improve overdose risk behaviors, and TAU to improve physical and psychological health. Conclusion There is no direct evidence related to the effect of health coaching on opioid reduction. There is limited, low quality evidence to conclude brief motivational interviewing reduces opioid usage in opioid-dependent patients. Future research should focus on the impact of high theoretical health coaching interventions on opioid usage.

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“…As noted above, previous work has examined integrated behavioral treatment for comorbid chronic pain and opioid misuse. Two recent trials of CBT failed to find evidence of reduction in pain interference 5,29 . The successful trials of Garland and colleagues 24,25 did not specifically recruit participants with evidence of ongoing opioid misuse.…”

Section: Analytic Approachmentioning

confidence: 99%

“…While previous work has been shown to reduce opioid misuse behaviors in those with chronic pain 34 , there are only a handful of interventions that have targeted both pain interference and hazardous opioid use in a coordinated fashion 65 . Two recent studies incorporating cognitive behavioral treatment (CBT) for substance use disorders with medication assisted treatment for opioid-treated chronic pain failed to have a significant effect on pain interference 5,29 . Naylor et al 43 used an Interactive Voice Response system as a follow-on to CBT for chronic pain and found it to have beneficial effect on both analgesic consumption and disability in comparison to no follow-up, although they did not measure opioid misuse specifically.…”

Section: Introductionmentioning

confidence: 99%

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

Vowles

Witkiewitz

Cusack

et al. 2020

The Journal of Pain

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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 painrelated 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 two 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 (UC) 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 (ITT) analyses and 32 individuals were included in per protocol (PP) 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 ITT and PP 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 Integrated treatment 3 examined feasibility and initial efficacy of an integrated behavioral treatment for Veterans.

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An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain

Cited by 65 publications

References 51 publications

Alcohol and Pain: A Translational Review of Preclinical and Clinical Findings to Inform Future Treatment Strategies

Alcohol and Pain: A Translational Review of Preclinical and Clinical Findings to Inform Future Treatment Strategies

Low theoretical fidelity hinders the research on health coaching for opioid reduction: A systematic review of randomized controlled trials

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

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