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Archambault L, Bertrand K, Martel MO, Bérubé M, Belhouari S, Perreault M. The current state of knowledge on care for co-occurring chronic pain and opioid use disorder: A scoping review. J Clin Nurs 2024; 33:3056-3076. [PMID: 38532646 DOI: 10.1111/jocn.17139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND AIMS Opioid use disorder often co-occurs with chronic pain but assessment and treatment of these co-occurring disorders is complex. This review aims to identify current treatments and delivery models for co-occurring chronic pain and opioid use disorder (OUD) documented in the scientific literature. DESIGN Scoping review. METHODS The review was conducted in six databases in June 2022 (no time limit): CINAHL, PsycINFO, Web of Science, Cochrane, PubMed and Embase. The PRISMA-ScR checklist was used to guide reporting. RESULTS Forty-seven publications addressing the issue of co-occurring chronic pain and OUD management were included. Randomized controlled trials provide evidence for the effectiveness of opioid agonist treatments (OAT) such as methadone or buprenorphine/naloxone, as well as for combining OAT with Mindfulness-Oriented Recovery Enhancement or cognitive behavioural therapy. A number of other pharmacological treatments (opioid and nonopioid), nonpharmacological treatments (e.g. physiotherapy) and service delivery models (e.g. simultaneous treatment of comorbidities, interdisciplinary and interprofessional collaboration) are also underlined. In most cases, authors recommend a combination of strategies to meet patient needs. CONCLUSIONS The scoping review reveals gaps in evidence-based knowledge to effectively care for co-occurring chronic pain and OUD, but several experts recommend the uptake of known 'best' practices such as integrated treatment of the multiple biopsychosocial dimensions of the co-occurring disorders as well as collaborative interdisciplinary work. CLINICAL RELEVANCE Improving services is dependent on alleviating barriers such as working in silos, the costs associated with nonpharmacological treatments, and the double stigma associated with pain in people with a substance use disorder.
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Affiliation(s)
- Léonie Archambault
- Université de Sherbrooke and Douglas Research Center, Montréal, Quebec, Canada
- Institut universitaire sur les dépendances, Direction de l'enseignement universitaire et de la recherche, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Karine Bertrand
- Institut Universitaire Sur les dépendances and Community Health Science Dept., Université de Sherbrooke, Longueuil, Quebec, Canada
| | - Marc O Martel
- Faculty of Dentistry & Department of Anesthesiology, McGill University, Montréal, Quebec, Canada
| | - Mélanie Bérubé
- Faculté Des Sciences infimières, Université Laval, Quebec City, Quebec, Canada
| | | | - Michel Perreault
- Douglas Research Center and Dept. of Psychiatry, McGill University, Montréal, Quebec, Canada
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Rossi R, Cutter CJ, Beitel M, Covelli M, Fiellin DA, Kerns RD, Vassilieva S, Olabisi D, Barry DT. Stepped Care for Patients to Optimize Whole Recovery (SC-POWR): An Effectiveness Trial Evaluating a Stepped Care Model for Individuals With Opioid Use Disorder and Chronic Pain. SUBSTANCE USE & ADDICTION JOURNAL 2024:29767342241245095. [PMID: 38606900 DOI: 10.1177/29767342241245095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Many patients who receive treatment for opioid use disorder (OUD) report experiencing chronic pain (CP), which is associated with high levels of ongoing nonmedical opioid use and low retention in OUD treatment. In pilot studies of patients with OUD receiving buprenorphine or methadone who had CP, cognitive behavioral therapy (CBT) attenuated nonmedical opioid use compared with treatment-as-usual (TAU), but patients in both treatment arms exhibited similar pain improvements. Adding exercise and stress reduction to this model may augment pain-related outcomes. With funding from National Institutes of Health, we plan to conduct a randomized clinical trial of 316 patients with OUD and CP to test the effectiveness of TAU compared with Stepped Care for Patients to Optimize Whole Recovery (SC-POWR) to reduce nonmedical opioid use and pain (primary outcomes) (Aim 1) and decrease pain intensity and interference, alcohol use, anxiety, depression and stress, and improve sleep (secondary outcomes) (Aim 2). Eligible participants will be randomized to receive TAU (buprenorphine or methadone and at least once a month individual or group counseling) or SC-POWR (ie, TAU and up to 12 CBT sessions) for 24 weeks. Based on prespecified nonresponse criteria, SC-POWR may be stepped up at week 6 to receive onsite weekly group sessions of exercise (Wii Fit, Tai Chi) and "stepped up" again at week 15 to receive weekly group sessions of stress reduction (relaxation training, auricular acupuncture). They will be followed for another 24 weeks to evaluate durability of treatment response for illicit opioid use, alcohol use, pain, anxiety, depression, stress, sleep, and retention in medications for OUD (Aim 3).
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Affiliation(s)
- Raiza Rossi
- Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Christopher J Cutter
- Yale Child Study Center, New Haven, CT, USA
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | | | - David A Fiellin
- Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Robert D Kerns
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Svetlana Vassilieva
- Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Declan T Barry
- Yale Child Study Center, New Haven, CT, USA
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA
- APT Foundation, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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MacLean RR, Ankawi B, Driscoll MA, Gordon MA, Frankforter TL, Nich C, Szollosy SK, Loya JM, Brito L, Ribeiro MIP, Edmond SN, Becker WC, Martino S, Sofuoglu M, Heapy AA. Efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT) in Individuals With Chronic Pain and Opioid Use Disorder: Protocol for a Randomized Clinical Trial of a Digital Cognitive Behavioral Treatment. JMIR Res Protoc 2024; 13:e54342. [PMID: 38506917 PMCID: PMC10993119 DOI: 10.2196/54342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/25/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Chronic pain is common among individuals with opioid use disorder (OUD) who are maintained on medications for OUD (MOUD; eg, buprenorphine or methadone). Chronic pain is associated with worse retention and higher levels of substance use. Treatment of individuals with chronic pain receiving MOUD can be challenging due to their increased clinical complexity. Given the acute and growing nature of the opioid crisis, MOUD is increasingly offered in a wide range of settings, where high-quality, clinician-delivered, empirically validated behavioral treatment for chronic pain may not be available. Therefore, digital treatments that support patient self-management of chronic pain and OUD have the potential for wider implementation to fill this gap. OBJECTIVE This study aims to evaluate the efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT), an interactive digital treatment program with asynchronous coach feedback, compared to treatment as usual (TAU) in individuals with chronic pain and OUD receiving MOUD. METHODS Adult participants (n=160) receiving MOUD and reporting bothersome or high-impact chronic pain will be recruited from outpatient opioid treatment programs in Connecticut (United States) and randomized 1:1 to either IMPACT+TAU or TAU only. Participants randomized to IMPACT+TAU will complete an interactive digital treatment that includes 9 modules promoting training in pain and addiction coping skills and a progressive walking program. The program is augmented with a weekly personalized voice message from a trained coach based on daily participant-reported pain intensity and interference, craving to use opioids, sleep quality, daily steps, pain self-efficacy, MOUD adherence, and engagement with IMPACT collected through digital surveys. Outcomes will be assessed at 3, 6, and 9 months post randomization. The primary outcome is MOUD retention at 3 months post randomization (ie, post treatment). Secondary outcomes include pain interference, physical functioning, MOUD adherence, substance use, craving, pain intensity, sleep disturbance, pain catastrophizing, and pain self-efficacy. Semistructured qualitative interviews with study participants (n=34) randomized to IMPACT (completers and noncompleters) will be conducted to evaluate the usability and quality of the program and its outcomes. RESULTS The study has received institutional review board approval and began recruitment at 1 site in July 2022. Recruitment at a second site started in January 2023, with a third and final site anticipated to begin recruitment in January 2024. Data collection is expected to continue through June 2025. CONCLUSIONS Establishing efficacy for a digital treatment for addiction and chronic pain that can be integrated into MOUD clinics will provide options for individuals with OUD, which reduce barriers to behavioral treatment. Participant feedback on the intervention will inform updates or modifications to improve engagement and efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT05204576; https://clinicaltrials.gov/ct2/show/NCT05204576. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54342.
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Affiliation(s)
- R Ross MacLean
- VA Connecticut Healthcare System, West Haven, CT, United States
- School of Medicine, Yale University, New Haven, CT, United States
| | - Brett Ankawi
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Mary A Driscoll
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Melissa A Gordon
- School of Medicine, Yale University, New Haven, CT, United States
| | | | - Charla Nich
- School of Medicine, Yale University, New Haven, CT, United States
| | - Sara K Szollosy
- VA Connecticut Healthcare System, West Haven, CT, United States
| | - Jennifer M Loya
- School of Medicine, Yale University, New Haven, CT, United States
| | - Larissa Brito
- School of Medicine, Yale University, New Haven, CT, United States
| | | | - Sara N Edmond
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - William C Becker
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, CT, United States
- School of Medicine, Yale University, New Haven, CT, United States
| | - Mehmet Sofuoglu
- VA Connecticut Healthcare System, West Haven, CT, United States
- School of Medicine, Yale University, New Haven, CT, United States
| | - Alicia A Heapy
- School of Medicine, Yale University, New Haven, CT, United States
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Health Services Research and Development Center of Innovation, VA Connecticut Healthcare System, West Haven, CT, United States
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DiMeola KA, Haynes J, Barone M, Beitel M, Madden LM, Cutter CJ, Raso A, Gaeta M, Zheng X, Barry DT. A Pilot Investigation of Nonpharmacological Pain Management Intervention Groups in Methadone Maintenance Treatment. J Addict Med 2022; 16:229-234. [PMID: 34145187 PMCID: PMC8678387 DOI: 10.1097/adm.0000000000000877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
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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Affiliation(s)
- Kimberly A DiMeola
- APT Foundation, Inc., New Haven, CT (KAD, JH, MB, MB, LMM, CJC, AR, MG, XZ, DTB), Yale School of Medicine, New Haven, CT (MB, LMM, CJC, AR, MG, DTB), Yale College, New Haven, CT (XZ)
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Mun CJ, Beitel M, Oberleitner L, Oberleitner DE, Madden LM, Bollampally P, Barry DT. Pain catastrophizing and pain acceptance are associated with pain severity and interference among methadone-maintained patients. J Clin Psychol 2019; 75:2233-2247. [PMID: 31454081 DOI: 10.1002/jclp.22842] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
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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Affiliation(s)
- Chung Jung Mun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Mark Beitel
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,APT Foundation, Inc, New Haven, Connecticut
| | - Lindsay Oberleitner
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,APT Foundation, Inc, New Haven, Connecticut
| | - David E Oberleitner
- APT Foundation, Inc, New Haven, Connecticut.,Department of Psychology, University of Bridgeport, Bridgeport, Connecticut
| | - Lynn M Madden
- APT Foundation, Inc, New Haven, Connecticut.,Department of Internal Medicine-AIDS, Yale School of Medicine, New Haven, Connecticut
| | - Pooja Bollampally
- APT Foundation, Inc, New Haven, Connecticut.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Declan T Barry
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,APT Foundation, Inc, New Haven, Connecticut.,Child Study Center, Yale School of Medicine, New Haven, Connecticut
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6
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Butner JL, Bone C, Ponce Martinez CC, Kwon G, Beitel M, Madden LM, Bono MH, Eller A, Barry DT. Training addiction counselors to deliver a brief psychoeducational intervention for chronic pain among patients in opioid agonist treatment: A pilot investigation. Subst Abus 2018. [DOI: 10.1080/08897077.2018.1449052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jenna L. Butner
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Curtis Bone
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Caridad C. Ponce Martinez
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Grace Kwon
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Mark Beitel
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Lynn M. Madden
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
| | - Madeline H. Bono
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
- New York University, Department of Psychology, New York, New York, USA
| | - Anthony Eller
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Declan T. Barry
- Yale School of Medicine, New Haven, Connecticut, USA
- Pain Treatment Services, The APT Foundation, Inc., New Haven, Connecticut, USA
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Beitel M, Oberleitner L, Kahn M, Kerns RD, Liong C, Madden LM, Ginn J, Barry DT. Drug Counselor Responses to Patients’ Pain Reports: A Qualitative Investigation of Barriers and Facilitators to Treating Patients with Chronic Pain in Methadone Maintenance Treatment. PAIN MEDICINE 2017; 18:2152-2161. [DOI: 10.1093/pm/pnw327] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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