Pain moderates changes in psychological flexibility but not substance use symptoms during substance use disorder treatment

Abstract

Pain-related problems frequently complicate substance use disorder (SUD) course and prognosis. However, it is unclear if the negative outcomes associated with co-occurring pain are due to its link with greater SUD severity, disruption of SUD treatment processes, or connection to a third psychological process. The current study modeled the longitudinal effects of pain during a 4-week intensive outpatient treatment (IOP) on SUD symptoms and limited psychological flexibility (PF), a common feature of psychological well being that is commonly restricted in both SUD and pain patients. After controlling for initial severity of SUD symptoms, current pain level at treatment intake moderated change in a subcomponent of PF, values commitment, but not SUD symptoms during the IOP. During the treatment, pain level also limited improvement in PF but not self-reported SUD symptoms. Targeting additional increases in psychological flexibility surrounding commitment to values during SUD treatment may help improve outcomes among patients who began treatment with significant pain symptoms.

Pain, psychological flexibility, and continued substance use in a predominantly hispanic adult sample receiving methadone treatment for opioid use disorder

“…An alternative explanation may be cultural differences in subjective pain experience; specifically, reports suggest that Hispanic adults tolerate pain differently (Hollingshead et al, 2016a). This is similar to Foster et al (2016) who found values commitment, but not substance use behavior, was moderated by pain in a sample of adults receiving treatment for OUD. It is worth noting that perhaps substance use behavior is explained by an interaction between psychological flexibility and pain; this relationship should be explored.…”