Open Access Open Access  Restricted Access Subscription or Fee Access

Psychosocial interventions for chronic pain and comorbid prescription opioid use disorders: A narrative review of the literature

Valerie Hruschak, MSW, Gerald Cochran, PhD, Ajay D. Wasan, MD, MSc

Abstract


Objective: Opioid misuse in the context of chronic noncancer pain (CNCP) is a multifaceted and complex issue. As opioid misuse and corresponding rates of addiction and overdose deaths exceed epidemic proportions, there is an urgent need for research in this area. The objective of this review is to evaluate the literature addressing psychosocial interventions targeting CNCP and prescription opioid misuse.

Design: A systematic search of PubMed, MEDLINE, PsychINFO, ClinicalTrials. gov was conducted to identify studies evaluating psychosocial interventions targeting CNCP and prescription opioid misuse. The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: 56 peer-reviewed research articles from 1993 to July, 2016, which included studies of psychosocial interventions for CNCP and opioid use disorders. Studies that examined psychosocial interventions for CNCP, treatment modalities included: cognitive behavioral therapy (CBT), acceptance and commitment therapy, mindfulness-based cognitive therapy and mindfulness-based stress reduction, and chronic pain self-management programs. The psychosocial interventions for opioid misuse included: CBT and relapse prevention, motivational enhancement therapy and stages of change, contingency management, and self-help and peer support-based groups.

Conclusions: The findings of this review offer clinical insight and reinforce the importance of psychosocial interventions in CNCP and opioid use disorders. However, little empirical data are available to guide practitioners in treating patients with CNCP who misuse opioid medications, and thus future research on integrated approaches, is needed.


Keywords


chronic pain, opioid misuse, psychosocial, integrated treatment

Full Text:

PDF

References


Protection P, Act AC: Patient protection and affordable care act. Public Law. 2010; 111: 48.

Ruddy R, House A: Psychosocial interventions for conversion disorder. Cochrane Library. 2005; doi: 10.1002/14651858.CD005331.pub2.

Abuse S: Mental Health Services Administration (2012) Results from the 2011 national survey on drug use and health: Summary of national findings. NSDUH Series H-44, HHS Publication No (SMA). 2014:12-4713.

Chang Y-P, Compton P: Management of chronic pain with chronic opioid therapy in patients with substance use disorders. Addict Sci Clin Pract. 2013; 8(1): 1.

Morasco BJ, Gritzner S, Lewis L, et al.: Systematic review of prevalence, correlates, and treatment outcomes for chronic non-cancer pain in patients with comorbid substance use disorder. PAIN®. 2011; 152(3): 488-497.

Ruetsch C: Empirical view of opioid dependence. J Manag Care Pharm. 2010; 16(1): 9-13.

Gilson AM, Kreis PG: The burden of the nonmedical use of prescription opioid analgesics. Pain Med. 2009; 10(S2): S89-S100.

Savage SR, Kirsh KL, Passik SD: Challenges in using opioids to treat pain in persons with substance use disorders. Addict Sci Clinic Pract. 2008; 4(2): 4.

Merskey HE: Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. Pain. 1986; Suppl 3, 226.

Cochran G, Woo B, Lo-Ciganic W-H, et al.: Defining nonmedical use of prescription opioids within health care claims: A systematic review. Subst Abuse. 2015; 36(2): 192-202.

Sehgal N, Manchikanti L, Smith HS: Prescription opioid abuse in chronic pain: A review of opioid abuse predictors and strategies to curb opioid abuse. Pain Phys. 2012; 15(suppl 3): ES67-ES92.

Boscarino JA, Hoffman SN, Han JJ: Opioid-use disorder among patients on long-term opioid therapy: Impact of final DSM-5 diagnostic criteria on prevalence and correlates. Subst Abuse Rehabil. 2015; 6: 83.

Miller SC, Frankowski D: Prescription opioid use disorder: A complex clinical challenge: Understanding patients' aberrant medication-taking behaviors can greatly aid treatment. Curr Psychiatr. 2012; 11(8): 14.

Chou R, Turner JA, Devine EB, et al.: The effectiveness and risks of long-term opioid therapy for chronic pain: A systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. 2015; 162(4): 276-286.

Roditi D, Robinson ME: The role of psychological interventions in the management of patients with chronic pain. Psychol Res Behav Manag. 2011; 4: 41-49.

Brady KT, McCauley JL, Back SE: Prescription opioid misuse, abuse, and treatment in the United States: An update. Am J Psychiatry. 2015; 173(1): 18-26.

Moher D, Shamseer L, Clarke M, et al.: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Rev. 2015; 4(1): 1.

Currie SR, Hodgins DC, Crabtree A, et al.: Outcome from integrated pain management treatment for recovering substance abusers. J Pain. 2003; 4(2): 91-100.

Khatami M, Woody G, O'Brien C: Chronic pain and narcotic addiction: A multitherapeutic approach—A pilot study. Comprehens Psychiatry. 1979; 20(1): 55-60.

Garland EL, Manusov EG, Froeliger B, et al.: Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: Results from an early-stage randomized controlled trial. J Consult Clinic Psychol. 2014; 82(3): 448.

Jamison RN, Ross EL, Michna E, et al.: Substance misuse treatment for high-risk chronic pain patients on opioid therapy: A randomized trial. Pain. 2010; 150(3): 390-400.

Lin LA, Bohnert AS, Price AM, et al.: Pain acceptance and opiate use disorders in addiction treatment patients with comorbid pain. Drug Alcohol Depend. 2015; 157: 136-142.

Kaiser RS, Mooreville M, Kannan K: Psychological interventions for the management of chronic pain: A review of current evidence. Curr Pain Headache Rep. 2015; 19(9): 1-8.

Morley S, Eccleston C, Williams A: Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain. 1999; 80(1): 1-13.

Ehde DM, Dillworth TM, Turner JA: Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. Am Psychol. 2014; 69(2): 153.

Richmond H, Hall AM, Copsey B, et al.: The effectiveness of cognitive behavioural treatment for non-specific low back pain: A systematic review and meta-analysis. PloS One. 2015; 10(8): e0134192.

Hoffman BM, Papas RK, Chatkoff DK, et al.: Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007; 26(1): 1.

Henschke N, Ostelo R, van Tulder MW, et al.: Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010; 7(7), doi: 10.1002/14651858.CD002014.pub3.

Eccleston C, Morley S, Williams AdC: Psychological approaches to chronic pain management: Evidence and challenges. Brit J Anaesth. 2013; 111(1): 59-63.

Hoffman S, Sawyer A, Fang A: The empirical status of the “new wave” of CBT,”. Psychiatr Clin North Am. 2010; 33(3): 701-710.

Song Y, Lu H, Chen H, et al.: Mindfulness intervention in the management of chronic pain and psychological comorbidity: A meta-analysis. Int J Nurs Sci. 2014; 1(2): 215-223.

Buhrman M, Skoglund A, Husell J, et al.: Guided internet-delivered acceptance and commitment therapy for chronic pain patients: A randomized controlled trial. Behav Res Ther. 2013; 51(6): 307-315.

Dahl J, Wilson KG, Nilsson A: Acceptance and commitment therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial. Behav Ther. 2004; 35(4): 785-801.

Wetherell JL, Afari N, Rutledge T, et al.: A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain. 2011; 152(9): 2098-2107.

Wicksell RK, Ahlqvist J, Bring A, et al.: Can exposure and acceptance strategies improve functioning and life satisfaction in people with chronic pain and Whiplash-Associated Disorders (WAD)? A randomized controlled trial. Cognitive Behav Ther. 2008; 37(3): 169-182.

Wicksell RK, Kemani M, Jensen K, et al.: Acceptance and commitment therapy for fibromyalgia: A randomized controlled trial. Eur J Pain. 2013; 17(4): 599-611.

Johnston M, Foster M, Shennan J, et al.: The effectiveness of an acceptance and commitment therapy self-help intervention for chronic pain. Clin J Pain. 2010; 26(5): 393-402.

McCracken LM, Vowles KE, Eccleston C: Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behav Res Ther. 2005; 43(10): 1335-1346.

Vowles KE, Wetherell JL, Sorrell JT: Targeting acceptance, mindfulness, and values-based action in chronic pain: Findings of two preliminary trials of an outpatient group-based intervention. Cognit Behav Pract. 2009; 16(1): 49-58.

Vowles KE, McCracken LM: Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process. J Consult Clin Psychol. 2008; 76(3): 397.

McCracken LM, Gutiérrez-Martínez O: Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy. Behav Res Ther. 2011; 49(4): 267-274.

Veehof MM, Oskam M-J, Schreurs KM, et al.: Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. PAIN®. 2011; 152(3): 533-542.

Bawa FLM, Mercer SW, Atherton RJ, et al.: Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis. Br J Gen Pract. 2015; 65(635): e387-e400.

Cramer H, Haller H, Lauche R, et al.: Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complement Alternative Med. 2012; 12(1): 1.

Veilleux JC, Colvin PJ, Anderson J, et al.: A review of opioid dependence treatment: Pharmacological and psychosocial interventions to treat opioid addiction. Clin Psychol Rev. 2010; 30(2): 155-166.

Lorig KR, Holman HR: Self-management education: History, definition, outcomes, and mechanisms. Ann Behav Med. 2003; 26(1): 1-7.

Manchikanti L, Falco FJ, Benyamin RM, et al.: Value-based interventional pain management: A review of medicare national and local coverage determination policies. Pain Phys. 2013; 16(3): E145-E180.

LeFort SM, Gray-Donald K, Rowat KM, et al.: Randomized controlled trial of a community-based psychoeducation program for the self-management of chronic pain. Pain. 1998; 74(2): 297-306.

McGillion M, LeFort SM, Webber K, et al.: Pain self-management: theory and process for clinicians. In: Lynch ME, Craig K, Peng PWH (eds.) Clinical Pain Management-A Practical Guide 1st ed Oxford: Wiley-Blackwell Publisher; 2011: 193-199.

McGillion MH, LeFort S, Stinson J: Chronic Pain Self- Management. Chronic pain: A health policy perspective. 2008: 167-181.

Blyth FM, March LM, Nicholas MK, et al.: Self-management of chronic pain: A population-based study. Pain. 2005; 113(3): 285-292.

Health WHODoM, Abuse S, Organization WH, Board INC, Drugs UNOo, Crime. Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. World Health Organization, 2009.

Marlatt GA, Donovan DM: Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. Guilford Press, 2005.

McHugh RK, Hearon BA, Otto MW: Cognitive behavioral therapy for substance use disorders. Psychiatr Clinics North Am. 2010; 33(3): 511-525.

Vedel E, Emmelkamp PM, Schippers GM: Individual cognitive- behavioral therapy and behavioral couples therapy in alcohol use disorder: A comparative evaluation in community-based addiction treatment centers. Psychother Psychosom. 2008; 77(5): 280-288.

Watkins KE, Hunter SB, Hepner KA, et al.: An effectiveness trial of group cognitive behavioral therapy for patients with persistent depressive symptoms in substance abuse treatment. Arch Gen Psychiatry. 2011; 68(6): 577-584.

Pan S, Jiang H, Du J, et al.: Efficacy of cognitive behavioral therapy on opiate use and retention in methadone maintenance treatment in China: A randomised trial. PloS One. 2015; 10(6): e0127598.

Irvin JE, Bowers CA, Dunn ME, et al.: Efficacy of relapse prevention: A meta-analytic review. J Consult Clin Psychol. 1999; 67(4): 563.

Dutra L, Stathopoulou G, Basden SL, et al.: A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry. 2008; 165(2): 179-87.

Magill M, Ray LA: Cognitive-behavioral treatment with adult alcohol and illicit drug users: A meta-analysis of randomized controlled trials. J Stud Alcohol Drugs. 2009; 70(4): 516-527.

Drummond DC, Perryman K: Psychosocial interventions in pharmacotherapy of opioid dependence: A literature review. London, St George's University of London, Division of Mental Health, Section of Addictive Behaviour. 2007.

DiClemente CC, Schlundt D, Gemmell L: Readiness and stages of change in addiction treatment. Am J Addict. 2004; 13(2): 103-119.

Miller WR, Yahne CE, Tonigan JS: Motivational interviewing in drug abuse services: A randomized trial. J Consult Clin Psychol. 2003; 71(4): 754.

Brown JM, Miller WR: Impact of motivational interviewing on participation and outcome in residential alcoholism treatment. Psychol Addict Behav. 1993; 7(4): 211.

Hettema J, Steele J, Miller WR: Motivational interviewing. Annu Rev Clin Psychol. 2005; 1: 91-111.

Smedslund G, Berg RC, Hammerstrom KT, et al.: Motivational interviewing for substance abuse. Cochrane Database Syst Rev. 2011; 5(5), doi: 10.1002/14651858.CD008063.pub2.

Higgins ST, Silverman KE: Motivating behavior change among illicit-drug abusers: Research on contingency management interventions. American Psychological Association, 1999.

Silverman K: Exploring the limits and utility of operant conditioning in the treatment of drug addiction. Behav Analyst. 2004; 27(2): 209.

Griffith JD, Rowan-Szal GA, Roark RR, et al.: Contingency management in outpatient methadone treatment: A meta-analysis. Drug Alcohol Depend. 2000; 58(1): 55-66.

Lussier JP, Heil SH, Mongeon JA, et al.: A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction. 2006; 101(2): 192-203.

Petry NM, Alessi SM, Hanson T, et al.: Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. J Consult Clin Psychol. 2007; 75(6): 983.

Petry NM, Martin B, Simcic Jr F: Prize reinforcement contingency management for cocaine dependence: Integration with group therapy in a methadone clinic. J Consult Clin Psychol. 2005; 73(2): 354.

Petry NM, Martin B: Low-cost contingency management for treating cocaine-and opioid-abusing methadone patients. J Consult Clin Psychol. 2002; 70(2): 398.

Schottenfeld RS, Chawarski MC, Pakes JR, et al.: Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence. Am J Psychiatry. 2005; 162(2): 340-349.

Kosten T, Oliveto A, Feingold A, et al.: Desipramine and contingency management for cocaine and opiate dependence in buprenorphine maintained patients. Drug Alcohol Depend. 2003; 70(3): 315-325.

Carroll KM, Sinha R, Nich C, et al.: Contingency management to enhance naltrexone treatment of opioid dependence: A randomized clinical trial of reinforcement magnitude. Experiment Clin Psychopharmacol. 2002; 10(1): 54.

Cochran G, Stitzer M, Campbell AN, et al.: Web-based treatment for substance use disorders: Differential effects by primary substance. Addict Behav. 2015; 45: 191-194.

Ferri M, Amato L, Davoli M: Alcoholics Anonymous and other 12-step programmes for alcohol dependence. Cochrane Database Systematic Rev. 2006; 3(2), doi : 10.1002/14651858.CD005032.pub2.

Timko C, DeBenedetti A: A randomized controlled trial of intensive referral to 12-step self-help groups: One-year outcomes. Drug Alcohol Depend. 2007; 90(2): 270-279.

McGonagle D: Methadone Anonymous: A 12-Step Program: Reducing the stigma of methadone use. J Psychosoc Nurs Ment Health Serv. 1994; 32(10): 5-9.

Ronel N, Gueta K, Abramsohn Y, et al.: Can a 12-step program work in methadone maintenance treatment? Int J Offender Ther Comparative Criminol. 2011; 55(7): 1135-1153.

Glickman L, Galanter M, Dermatis H, et al.: Pathways to recovery: Adapting 12-step recovery to methadone treatment. J Maintenance Addictions. 2005; 2(4): 77-90.

Kownacki RJ, Shadish WR: Does Alcoholics Anonymous work? The results from a meta-analysis of controlled experiments. Subst Use Misuse. 1999; 34(13): 1897-1916.

Morasco BJ, Corson K, Turk DC, et al.: Association between substance use disorder status and pain-related function following 12 months of treatment in primary care patients with musculoskeletal pain. J Pain. 2011; 12(3): 352-359.

Upshur CC, Luckmann RS, Savageau JA: Primary care provider concerns about management of chronic pain in community clinic populations. J General Intern Med. 2006; 21(6): 652-655.

Edlund MJ, Martin BC, Fan M-Y, et al.: Risks for opioid abuse and dependence among recipients of chronic opioid therapy: Results from the TROUP study. Drug Alcohol Depend. 2010; 112(1): 90-98.

Wasan AD, Butler SF, Budman SH, et al.: Psychiatric history and psychologic adjustment as risk factors for aberrant drug-related behavior among patients with chronic pain. Clin J Pain.

; 23(4): 307-315.

Manchikanti L, Giordano J, Boswell MV, et al.: Psychological factors as predictors of opioid abuse and illicit drug use in chronic pain patients. J Manag. 2007; 5: 8.

Institute of Medicine Committee on Advancing Pain Research C, Education. The National Academies Collection: Reports funded by National Institutes of Health. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US) National Academy of Sciences, 2011.

Gatchel RJ, Okifuji A: Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. J Pain. 2006; 7(11): 779-793.

Nedeljkovic SS, Wasan A, Jamison RN: Assessment of efficacy of long-term opioid therapy in pain patients with substance abuse potential. Clin J Pain. 2002; 18(4): S39-S51.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016; 315(15), 1624–1645. doi:10.1001/jama.2016.1464.

Chapman CR, Lipschitz DL, Angst MS, et al.: Opioid pharmacotherapy for chronic non-cancer pain in the United States: A research guideline for developing an evidence-base. J Pain. 2010; 11(9): 807-829.

Turk DC, Rudy TE: Toward an empirically derived taxonomy of chronic pain patients: Integration of psychological assessment data. J Consult Clin Psychol. 1988; 56(2): 233.

VanDenKerkhof EG, Peters ML, Bruce J: Chronic pain after surgery: Time for standardization? A framework to establish core risk factor and outcome domains for epidemiological studies. Clin J Pain. 2013; 29(1): 2-8.

Pillastrini P, Gardenghi I, Bonetti F, et al.: An updated overview of clinical guidelines for chronic low back pain management in primary care. Joint Bone Spine. 2012; 79(2): 176-185.

Koes BW, van Tulder M, Lin C-WC, et al.: An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010; 19(12): 2075-2094.

Treatment CfSA. Managing chronic pain in adults with or in recovery from substance use disorders. 2012.

Clark MR, Treisman GJ: Chronic pain and addiction. Karger Medical and Scientific Publishers, 2011.




DOI: http://dx.doi.org/10.5055/jom.2018.0467

Refbacks

  • There are currently no refbacks.
This site uses cookies to maintain session information critical to the user's experience and environment on this system. Click "Accept Cookies" to continue.
For more details please visit our privacy statement at: Privacy & GDPR