Web-Based CBT Adjunct May Address Aberrant Drug-Related Behaviors in Chronic Pain

A web-based cognitive behavior therapy (CBT) program may be associated with greater reductions in aberrant drug-related behavior, pain interference, and pain catastrophizing in patients with chronic pain treated with opioids who undergo treatment as usual compared with patients who undergo treatment as usual only, according to a randomized study published in Pain Medicine.

Participants with chronic pain who were being treated with opioids and who endorsed ≥4 items on the 17-point Current Opioid Misuse Measure (COMM) were included in the analysis (n=110).

Investigators randomly assigned patients to receive treatment as usual alone (n=55) or in combination with a web-based self-management cognitive behavior program (Take Charge of Pain program; n=55).

The primary outcomes assessed during the 12-week study period included pain interference, pain severity and aberrant drug-related behavior (both emotional and cognitive), assessed with COMM .

At baseline, the mean Multidimensional Pain Inventory (MPI) pain interference score was 4.74±1.01 (range, 2.2-6) and the mean score on the MPI pain severity subscale was  4.67±0.98 (range, 2-6). The average COMM score was 15.7±7.57 (range, 4-39), above the 9-point cut-off for defining clinically significant aberrant drug-related behavior.

The web-based Take Charge of Pain program was associated with a high acceptance rate in participants as indicated by high mean visual analog scale scores. Based on the COMM score, participants randomly assigned to the web-based CBT program reported greater reductions in aberrant drug-related behavior during the study period compared with those receiving treatment as usual alone (6.96-point reduction vs 2.55-point reduction, respectively; P =.001). These improvements were sustained at 3 months following intervention.

In addition, participants in the web-based program vs standard treatment alone had a greater reduction in Pain Catastrophizing Scale score (8.08-point reduction vs 3.43-point reduction, respectively; P =.040) and fewer 6-month emergency department visits for pain (38% vs 18%, respectively; P =.004).

Considering investigators relied on patient self-report to evaluate outcome variables, the study may be limited by participants’ poor recall or report inaccuracies due to social desirability. Also, patients in this study were managed for chronic pain at a specialized tertiary pain center, which reduces the generalizability of the findings to patients with less severe pain receiving care in nonspecialized settings.

 “A widely accessible self-management intervention has the potential to assist clinicians who must address [aberrant drug-related behavior] in a clinically appropriate manner and support patients as they work to avoid negative outcomes, better manage their use of opioid medications, and improve their experience of living with chronic pain,” concluded the investigators.

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Reference

Guarino H, Fong C, Marsch LA, et al. Web-based cognitive behavior therapy for chronic pain patients with aberrant drug-related behavior: outcomes from a randomized controlled trial [published January 13, 2018]. Pain Med. doi:10.1093/pm/pnx334