A randomized trial of a pain management intervention for adults receiving substance use disorder treatment

作者：Ilgen Mark A^*; Bohnert Amy S B; Chermack Stephen; Conran Carly; Jannausch Mary; Trafton Jodie; Blow Frederic C

来源：Addiction, 2016, 111(8): 1385-1393.

DOI：10.1111/add.13349

• Cognitive-behavioral
• pain
• substance use disorder

Background and AimsChronic pain is difficult to treat in individuals with substance use disorders and, when not resolved, can have a negative impact on substance use disorder treatment outcomes. This study tested the efficacy of a psychosocial pain management intervention, ImPAT (improving pain during addiction treatment), that combines pain management with content related to managing pain without substance use.
DesignSingle-site, parallel-groups randomized controlled trial comparing ImPAT to a supportive psychoeducational control (SPC) condition; follow-up assessments occurred at 3, 6 and 12 months.
SettingThe Ann Arbor VA Substance Use Disorder treatment program, USA.
ParticipantsVeterans Health Administration patients {n=129; mean [standard deviation (SD)], age=51.7 (9.5); 115 of 129 (89%) male; ImPAT (n=65); SPC (n=64)}.
InterventionImPAT combines principles of cognitive-behavioral therapy and acceptance-based approaches to pain management with content related to avoiding the use of substances as a coping mechanism for pain. The SPC used a psychoeducational attention control treatment for alcoholism modified to cover other substances in addition to alcohol.
MeasurementsPrimary: Pain intensity over 12 months; secondary: pain-related functioning, frequency of alcohol and drug use over 12 months.
FindingsPrimary: randomization to the ImPAT intervention versus SPC predicted significantly lower pain intensity { [standard error (SE)]=-0.71 (0.29); 95% confidence interval (CI)=-1.29, -0.12}; secondary: relative to the SPC condition, those who received ImPAT also reported improved pain-related functioning [ (SE)=0.27 (0.11); 95% CI=0.05, 0.49] and lower frequency of alcohol consumption [ (SE)=-0.77; 95% CI=-1.34, -0.20]. No differences were found between conditions on frequency of drug use over follow-up.
ConclusionsFor adults with pain who are enrolled in addictions treatment, receipt of a psychological pain management intervention (improving pain during addiction treatment) reduced pain and alcohol use and improves pain-related functioning over 12 months relative to a matched-attention control condition.

• 出版日期2016-8