Web-Based Pain Management Program Reduces Aberrant Drug Behavior in Chronic Pain

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Patients were considered to exhibit aberrant drug-related behavior if they reported ≥4 items on the Current Opioid Misuse Measure.
Patients were considered to exhibit aberrant drug-related behavior if they reported ≥4 items on the Current Opioid Misuse Measure.

A web-based self-management program may reduce aberrant drug behaviors and pain catastrophizing in patients with chronic pain treated with opioids, according to a recent study published in Pain Medicine.

In this prospective study, 110 patients treated with opioids for their moderate to severe chronic pain (score ≥5 on the 0 to 10 Brief Pain Inventory; pain for ≥3 months) who displayed aberrant drug-related behavior, as indicated by ≥4 reported items with >0 response on the Current Opioid Misuse Measure, were randomly assigned to receive standard care with or without a web-based “Take Charge of Pain” program.

The Take Charge of Pain program is based on cognitive behavioral therapy principles and was designed to restructure dysfunctional thinking about pain and provide pain coping skills. Pain severity, pain interference, and aberrant drug behavior during the 12-week intervention and at 1 and 3 months post-intervention were the primary outcomes. Secondary outcomes included pain catastrophizing and pain-related emergency department visits.

Aberrant drug-related behavior was found to be reduced in patients receiving the web-based program in addition to standard care vs standard care alone during the treatment period (P =.001). Both groups had similar reductions in aberrant drug-related behavior at 1- and 3-month follow-up. Pain severity and pain interference were reduced from baseline during the intervention period in both groups, and the reductions were maintained during post-intervention follow-up. During the intervention period, pain catastrophizing was reduced in the web-based program group relative to standard of care (P =.04). In a similar manner, the percentage of patients reporting a reduced number of pain-related emergency department visits was lower in the web-based group during the entire study period (P =.004).

In an interview with Clinical Pain Advisor, Honoria Guarino, PhD, principal investigator at the National Development and Research Institutes, Inc, New York, explained that "self-management interventions, many of them based on cognitive behavior therapy principles and techniques, have been found [to be] broadly effective in helping patients better cope with their pain, reduce their pain-related distress and mitigate the negative effect that pain so often has on their lives. And, unlike opioid medications, behavioral interventions are very safe, without the serious side effects and risks associated with opioids."

Dr Guarino concluded that "broader dissemination of tools like the Take Charge of Pain program, if found effective, may have an important role to play in reducing chronic pain patients' reliance on opioid medications and may, therefore, contribute to efforts to address the opioid epidemic."

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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 online January 13, 2018]. Pain Med. doi:10.1093/pm/pnx334

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