Physical activity, psychiatric distress, and interest in exercise group participation among individuals seeking methadone maintenance treatment with and without chronic pain

Beitel, Mark; Stults‐Kolehmainen, Matthew; Cutter, Christopher J.; Schottenfeld, Richard S.; Eggert, Kathy; Madden, Lynn M.; Kerns, Robert D.; Liong, Christopher; Ginn, Joel; Barry, Declan T.

doi:10.1111/ajad.12336

Cited by 19 publications

(29 citation statements)

References 37 publications

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“…28 Similarly, the game and fun aspects of Wii-Covery may help to counter the low interest in participating in exercise groups reported by patients in MMT. 23,29 Our findings regarding acute improvements in current pain intensity and specific mood states associated with a single session attendance of Wii-Covery extend those from a previous pilot randomized clinical trial which found that repeated attendance at onsite individual Wii Fit sessions was associated with increased offsite exercise. 23 To our knowledge, this is the first study to investigate the feasibility of conducting Juggling Group as an NPMI in MMT.…”

Section: Pre-post Session Changessupporting

confidence: 78%

A Pilot Investigation of Nonpharmacological Pain Management Intervention Groups in Methadone Maintenance Treatment

DiMeola

Haynes

Barone

et al. 2021

Journal of Addiction Medicine

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Objectives: We examined the feasibility (i.e., single-session attendance) of conducting 3 counselor-delivered nonpharmacological pain management intervention (NPMI) groups in methadone maintenance treatment (MMT): (1) Coping with Pain, an intervention based on cognitive-behavioral therapy, (2) Wii-Covery, an exergame intervention to facilitate exercise, and (3) Juggling Group, an intervention to promote social inclusion and reduce stress. We examined pre-post session changes in pain and mood associated with group attendance. Methods: Over 1 month at an MMT clinic with 1800 patients, each NPMI group was offered daily Monday-Friday and 1 was offered on Saturdays. A standardized but unvalidated measure was administered before and after sessions to assess acute changes in current pain intensity and mood states. Paired t-tests with Bonferroni corrections were performed for each NPMI group (P < 0.0007 [.05/7]). Results: About 452 patients (67% male, 84% White, mean age, 40) attended at least 1 NPMI group. About 57% reported current chronic pain. Attendance at any NPMI group (for the whole sample and the subset with chronic pain) was significantly associated with acute reductions in current pain intensity, anxiety, depression, and stress, and acute increases in current energy and happiness. Attendance at Coping with Pain and Juggling Group was also associated with acute increases in compassion. Conclusions: Coping with Pain, Wii-Covery, and Juggling Group are feasible to conduct in MMT, and acute improvements in current pain intensity and specific mood states associated with a single session attendance point to the importance of examining systematically the efficacy of these and other NPMIs in MMT.

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Section: Pre-post Session Changessupporting

confidence: 78%

A Pilot Investigation of Nonpharmacological Pain Management Intervention Groups in Methadone Maintenance Treatment

DiMeola

Haynes

Barone

et al. 2021

Journal of Addiction Medicine

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“…Future studies could evaluate whether the inclusion of additional pain-focused interventions with CBT improves pain outcomes. Increased engagement in exercise and behavioral activation may be good initial targets, considering findings that for patients receiving MMT chronic pain is associated with decreased likelihood of meeting public health guidelines for physical activity, and the important role that deconditioning plays in perpetuating chronic back pain (Beitel et al, 2016; Qaseem et al, 2017). Findings from recent studies suggest that mindfulness-based interventions might also be useful to explore (Garland et al, 2017; Smallwood et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

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

Barry

Beitel

Cutter

et al. 2019

Drug and Alcohol Dependence

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Aims: The primary study aim was to evaluate the feasibility and acceptability of cognitive-behavioral therapy (CBT) for opioid use disorder and chronic pain. The secondary aim was to examine its preliminary efficacy. Methods: In a 12-week pilot randomized clinical trial, 40 methadone-maintained patients were assigned to receive weekly manualized CBT (n=21) or Methadone Drug Counseling (MDC) to approximate usual drug counseling (n=19). Results: Twenty of 21 patients assigned to CBT and 18 of 19 assigned to MDC completed the pilot study. Mean (SD) sessions attended were 8.4 (2.9) for CBT (out of 12 possible) and 3.8 (1.1) for MDC (out of 4 possible); mean (SD) patient satisfaction ratings (scored on1–7 Likert-type scales) were 6.6 (0.5) for CBT and 6.0 (0.4) for MDC (p<.001). The proportion of patients abstinent during the baseline and each successive 4-week interval was higher for patients assigned to CBT than for those assigned to MDC [Wald χ2 (1) = 5.47, p=.02]; time effects (p=.69) and interaction effects between treatment condition and time (p=.10) were not significant. Rates of clinically significant change from baseline to end of treatment on pain interference (42.9% vs. 42.1%, [χ2 (1, N=40)=0.002, p=0.96]) did not differ significantly for patients assigned to CBT or MDC. Conclusions: We found support for the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy relative to standard drug counseling in promoting abstinence from nonmedical opioid use among patients with opioid use disorder and chronic pain. Overall, patients exhibited improved pain outcomes, but these improvements did not differ significantly by treatment condition.

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“…27 Several observational and self-report studies also support the acceptability and potential of adjunctive exercise interventions to improve OMT outcomes. For example, one study 28 showed that individuals seeking methadone maintenance treatment reported no moderate or vigorous intensity physical activity in the past week, while 24% reported interest in exercise group participation. Participants who met recommended levels of physical activity in the past week had significantly lower levels of depression compared to participants that did not.…”

Section: Substance Abuse: Research and Treatmentmentioning

confidence: 99%

Aerobic Exercise Interventions for Patients in Opioid Maintenance Treatment: A Systematic Review

et al. 2020

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Background: Opioid maintenance treatment (OMT) is the standard for treatment of opioid use disorder, but some individuals on OMT experience disrupted sleep, heightened sensitivity to pain, and continued relapse to non-medical opioid use. An adjunctive treatment that has potential to address these shortcomings of OMT is aerobic exercise. Objective: The aim of the present review was to identify and evaluate components of aerobic exercise interventions targeting OMT patients. Methods: For this PROSPERO-registered review (ID CRD42020139626), studies were identified via electronic bibliographic databases, funded research ( NIH RePORTER) and clinical trials databases ( ClinicalTrials.gov), and reference sections of relevant manuscripts. Studies that evaluated the effects of an aerobic exercise intervention using a comparison condition or pretest-posttest design in adult OMT patients were included. Results: Of 2971 unique records, three primary studies and one supplemental manuscript comprised the final sample. All studies were randomized trials involving supervised exercise interventions enrolling small samples of middle-aged OMT patients. Exercise interventions included a variety of aerobic and non-aerobic activities (e.g. flexibility exercises), and none controlled the dose of aerobic exercise. Few studies used objective measures of physical activity or cardiorespiratory fitness and there were no significant effects of adjunctive exercise on substance use outcomes, but tests of the latter were likely underpowered. Conclusions: Though early in the accumulation of evidence, interventions targeting aerobic exercise for OMT patients appear feasible, acceptable to patients, and beneficial. Longer-term studies that employ larger samples, include assessments of behavioral and biological mechanisms of change, more rigorous measurement of physical activity, and controlled doses of aerobic activity are warranted.

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Physical activity, psychiatric distress, and interest in exercise group participation among individuals seeking methadone maintenance treatment with and without chronic pain

Abstract: Low levels of physical activity and low interest in exercise group participation among patients entering MMT point to the need for and likely challenges of implementing exercise interventions in MMT.

Cited by 19 publications

References 37 publications

A Pilot Investigation of Nonpharmacological Pain Management Intervention Groups in Methadone Maintenance Treatment

A Pilot Investigation of Nonpharmacological Pain Management Intervention Groups in Methadone Maintenance Treatment

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

Aerobic Exercise Interventions for Patients in Opioid Maintenance Treatment: A Systematic Review

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