Drug Counselor Responses to Patients’ Pain Reports: A Qualitative Investigation of Barriers and Facilitators to Treating Patients with Chronic Pain in Methadone Maintenance Treatment

Beitel, Mark; Oberleitner, Lindsay; Kahn, Marissa; Kerns, Robert D.; Liong, Christopher; Madden, Lynn M.; Ginn, Joel; Barry, Declan T.

doi:10.1093/pm/pnw327

Cited by 17 publications

(36 citation statements)

References 40 publications

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“…In addition to the foregoing issues, there are other factors that have received little to no attention in the literature, and accounting for them in incentive mechanisms can yield more impactful outcomes: The co-occurrence of OUD/SUD and chronic pain can impose pressure on providers due to multi-layered and complex treatment requirements, lack of patient improvement for either condition, and care fragmentation caused by ineffective pain management referrals [ 6 ]. Guidelines that promote curbing the supply of opioids may have unintended consequences such as the increase in the number of deaths caused by fentanyl misuse.…”

Section: Discussionmentioning

confidence: 99%

“…The co-occurrence of OUD/SUD and chronic pain can impose pressure on providers due to multi-layered and complex treatment requirements, lack of patient improvement for either condition, and care fragmentation caused by ineffective pain management referrals [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…A myriad of factors have been attributed to the opioid crisis. These include: Regulations on reimbursement policies, such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which partially rewards healthcare systems and providers when patients score high on pain management experience of care, thus making providers more inclined towards opioid analgesics [ 4 ]; Lack of a comprehensive multi-modal pain management strategy [ 5 ]; Barriers in adopting treatments for opioid /substance use disorders [ 6 ]; Efforts that have influenced downplaying the negative impacts of opioids, such as marketing by pharmaceutical companies and professional associations promoting opioids [ 7 ] or pain being declared as the fifth vital sign [ 8 ]; Regarding the novel coronavirus 2019 (COVID-19) pandemic, we note that second-order effects have been reported on the opioid crisis; e.g., an increase in rates of opioid use disorders [ 9 ] and opioid use in intensive care units during mechanical ventilation [ 10 ]. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Misalignment of Stakeholder Incentives in the Opioid Crisis

Boloori

Arnetz

Viens

et al. 2020

IJERPH

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The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients’ non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Misalignment of Stakeholder Incentives in the Opioid Crisis

Boloori

Arnetz

Viens

et al. 2020

IJERPH

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“…Although it was beyond the scope of the present study, it is important to note that individuals on MMT not only have high prevalence of co-occurring chronic pain but also high psychiatric comorbidity (Beitel et al, 2017;Fei, Yee, Habil, & Bin, 2015;Rosic et al, 2017). Stepped care approach (Bower & Gilbody, 2005) Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012; Khoury et al, 2013), to our knowledge, none of the previous studies explored the utility of these interventions in treating tri-morbidity.…”

mentioning

confidence: 97%

“…Although it was beyond the scope of the present study, it is important to note that individuals on MMT not only have high prevalence of co-occurring chronic pain but also high psychiatric comorbidity (Beitel et al, 2017;Fei, Yee, Habil, & Bin, 2015;Rosic et al, 2017). Stepped care approach (Bower & Gilbody, 2005) might be potentially useful in clinical settings so that MMT patients with tri-morbidity (OUD + chronic pain + other psychiatric condition) receive more resource-intensive treatment from providers.…”

mentioning

confidence: 99%

Pain catastrophizing and pain acceptance are associated with pain severity and interference among methadone‐maintained patients

Mun¹,

Beitel

Oberleitner

et al. 2019

J Clin Psychol

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Objective The present study examined whether pain catastrophizing and pain acceptance, two important targets of psychosocial interventions for chronic pain, are uniquely associated with pain severity and pain interference among patients on methadone maintenance treatment (MMT). Method A total of 133 MMT patients who reported experiencing some pain during the previous week completed a battery of self‐report measures. Multiple regression was used to test whether pain catastrophizing and pain acceptance are related to pain severity and pain interference above and beyond covariates including demographics, emotional distress, and current methadone dose. Results Both pain acceptance and catastrophizing were significantly associated with pain severity and pain interference while controlling for covariates. Conclusions Consistent with previous literature on patients with chronic pain but without opioid use disorder, our findings suggest that both pain catastrophizing and pain acceptance are potentially important intervention targets among MMT patients with co‐occurring opioid use disorder and chronic pain.

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Telehealth Mindfulness-Oriented Recovery Enhancement vs Usual Care in Individuals With Opioid Use Disorder and Pain

Cooperman,

Lu,

Hanley

et al. 2024

JAMA Psychiatry

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ImportanceMethadone treatment (MT) fails to address the emotion dysregulation, pain, and reward processing deficits that often drive opioid use disorder (OUD). New interventions are needed to address these factors.ObjectiveTo evaluate the efficacy of MT as usual (usual care) vs telehealth Mindfulness-Oriented Recovery Enhancement (MORE) plus usual care among people with an OUD and pain.Design, Setting, and ParticipantsThis study was a randomized clinical trial conducted from August 2020 to June 2022. Participants receiving MT for OUD and experiencing chronic pain were recruited at 5 clinics in New Jersey.InterventionsIn usual care, participants received MT, including medication and counseling. Participants receiving MORE plus usual care attended 8 weekly, 2-hour telehealth groups that provided training in mindfulness, reappraisal, and savoring in addition to usual care.Main Outcomes and MeasurePrimary outcomes were return to drug use and MT dropout over 16 weeks. Secondary outcomes were days of drug use, methadone adherence, pain, depression, and anxiety. Analyses were based on an intention-to-treat approach.ResultsA total of 154 participants (mean [SD] age, 48.5 [11.8] years; 88 female [57%]) were included in the study. Participants receiving MORE plus usual care had significantly less return to drug use (hazard ratio [HR], 0.58; 95% CI, 0.37-0.90; P = .02) and MT dropout (HR, 0.41; 95% CI, 0.18-0.96; P = .04) than those receiving usual care only after adjusting for a priori–specified covariates (eg, methadone dose and recent drug use, at baseline). A total of 44 participants (57.1%) in usual care and 39 participants (50.6%) in MORE plus usual care returned to drug use. A total of 17 participants (22.1%) in usual care and 20 participants (13.0%) in MORE plus usual care dropped out of MT. In zero-inflated models, participants receiving MORE plus usual care had significantly fewer days of any drug use (ratio of means = 0.58; 95% CI, 0.53-0.63; P &lt; .001) than those receiving usual care only through 16 weeks. A significantly greater percentage of participants receiving MORE plus usual care maintained methadone adherence (64 of 67 [95.5%]) at the 16-week follow-up than those receiving usual care only (56 of 67 [83.6%]; χ2 = 4.49; P = .04). MORE reduced depression scores and ecological momentary assessments of pain through the 16-week follow-up to a significantly greater extent than usual care (group × time F2,272 = 3.13; P = .05 and group × time F16,13000 = 6.44; P &lt; .001, respectively). Within the MORE plus usual care group, EMA pain ratings decreased from a mean (SD) of 5.79 (0.29) at baseline to 5.17 (0.30) at week 16; for usual care only, pain decreased from 5.19 (0.28) at baseline to 4.96 (0.29) at week 16. Within the MORE plus usual care group, mean (SD) depression scores were 22.52 (1.32) at baseline and 18.98 (1.38) at 16 weeks. In the usual care–only group, mean (SD) depression scores were 22.65 (1.25) at baseline and 20.03 (1.27) at 16 weeks. Although anxiety scores increased in the usual care–only group and decreased in the MORE group, this difference between groups did not reach significance (group × time unadjusted F2,272 = 2.10; P= .12; Cohen d = .44; adjusted F2,268 = 2.33; P = .09). Within the MORE plus usual care group, mean (SD) anxiety scores were 25.5 (1.60) at baseline and 23.45 (1.73) at 16 weeks. In the usual care–only group, mean (SD) anxiety scores were 23.27 (1.75) at baseline and 24.07 (1.73) at 16 weeks.Conclusions and RelevanceThis randomized clinical trial demonstrated that telehealth MORE was a feasible adjunct to MT with significant effects on drug use, pain, depression, treatment retention, and adherence.Trial RegistrationClinicalTrials.gov Identifier: NCT04491968

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Drug Counselor Responses to Patients’ Pain Reports: A Qualitative Investigation of Barriers and Facilitators to Treating Patients with Chronic Pain in Methadone Maintenance Treatment

Abstract: Perceived barriers to treating patients with chronic noncancer pain are common among drug counselors. Addressing these barriers in drug counselor training and in methadone maintenance treatment programs may benefit both methadone-maintained patients with chronic pain and their providers.

Cited by 17 publications

References 40 publications

Misalignment of Stakeholder Incentives in the Opioid Crisis

Misalignment of Stakeholder Incentives in the Opioid Crisis

Pain catastrophizing and pain acceptance are associated with pain severity and interference among methadone‐maintained patients

Telehealth Mindfulness-Oriented Recovery Enhancement vs Usual Care in Individuals With Opioid Use Disorder and Pain

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