Behavioral Program Improves Chronic Pain Outcomes in Substance Use Disorder

Therapist with patient
Behavioral management of chronic pain may improve addiction treatment outcomes.

Behavioral pain management during addiction treatment is associated with better pain-related outcomes, but not substance use-related outcomes, according to results of a randomized clinical trial published in JAMA Psychiatry.

An important aspect of addiction treatment is to address an individual’s pain as well as substance use. Chronic pain is common among individuals with substance use disorders (SUDs) and is associated with poorer addiction treatment outcomes, yet current treatments for substance-use do not include pain management.

To determine if an integrated behavioral pain management intervention (ImPAT) effectively reduces pain in individuals with SUDs, data from 510 participants (44.73% women) were analyzed. Participants were randomly assigned to receive either ImPAT or supportive psychoeducational control (SPC) treatments in equal proportions. The mean age of participants was 34.8±10.3 years. Each treatment consisted of 8 sessions and outcome analysis was conducted at 3, 6, and 12 months post-baseline.

The ImPAT program focuses on how psychosocial pain is associated with functioning and relapse prevention and provides skills to manage pain. SPC served as the active control condition and included discussions of topics such as nutrition and the course of addiction.

ImPAT treatment was associated with a significantly higher tolerance of pain among men at 3 months (P =.004), but this difference was not significant after 12 months. Women who underwent ImPAT treatment experienced a reduction in pain intensity from 3 to 12 months compared with women receiving the SPC treatment, who experienced an increase in pain over the same period (P =.08).

No differences in alcohol or drug use was found between individuals treated with ImPAT and those treated with SPC after the 12 month period.

The results of this study showed that incorporating behavioral pain management into addiction treatment improves pain tolerance in men and pain intensity in women. As chronic pain has been shown to negatively impact addiction treatment outcomes, behavioral pain management may improve addiction treatment outcomes.

Limitations to this study include the lack of data regarding the source or duration of participants’ pain at baseline.

Further investigation into enhanced methods for integrated pain and SUD treatments to improve clinical outcomes is warranted.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Ilgen MA, Coughlin LN, Bohnert ASB, et al. Efficacy of a psychosocial pain management intervention for men and women with substance use disorders and chronic pain. Published online July 29, 2020. JAMA Psychiatry.  oi:10.1001/jamapsychiatry.2020.2369