A randomized trial of a pain management intervention for adults receiving substance use disorder treatment

Abstract

Background and AimsChronic pain is difficult to treat in individuals with substance use disorders and, when not resolved, can have a negative impact on substance use disorder treatment outcomes. This study tested the efficacy of a psychosocial pain management intervention, ImPAT (improving pain during addiction treatment), that combines pain management with content related to managing pain without substance use.DesignSingle‐site, parallel‐groups randomized controlled trial comparing ImPAT to a supportive psychoeducational control (SPC) condition; follow‐up assessments occurred at 3, 6 and 12 months.SettingThe Ann Arbor VA Substance Use Disorder treatment program, USA.ParticipantsVeterans Health Administration patients {n = 129; mean [standard deviation (SD)], age = 51.7 (9.5); 115 of 129 (89%) male; ImPAT (n = 65); SPC (n = 64)}.InterventionImPAT combines principles of cognitive–behavioral therapy and acceptance‐based approaches to pain management with content related to avoiding the use of substances as a coping mechanism for pain. The SPC used a psychoeducational attention control treatment for alcoholism modified to cover other substances in addition to alcohol.MeasurementsPrimary: Pain intensity over 12 months; secondary: pain‐related functioning, frequency of alcohol and drug use over 12 months.FindingsPrimary: randomization to the ImPAT intervention versus SPC predicted significantly lower pain intensity {β [standard error (SE)] = −0.71 (0.29); 95% confidence interval (CI) = −1.29, −0.12}; secondary: relative to the SPC condition, those who received ImPAT also reported improved pain‐related functioning [β (SE) = 0.27 (0.11); 95% CI = 0.05, 0.49] and lower frequency of alcohol consumption [β (SE) = −0.77; 95% CI = −1.34, −0.20]. No differences were found between conditions on frequency of drug use over follow‐up.ConclusionsFor adults with pain who are enrolled in addictions treatment, receipt of a psychological pain management intervention (improving pain during addiction treatment) reduced pain and alcohol use and improves pain‐related functioning over 12 months relative to a matched‐attention control condition.