School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
Department of Psychology, University of New Mexico, Albuquerque, New Mexico.
J Pain. 2020 Jul-Aug;21(7-8):798-807. doi: 10.1016/j.jpain.2019.11.007. Epub 2019 Nov 21.
Opioid prescription in the treatment of chronic pain is frequent and carries a risk of increased morbidity and mortality in a clinically significant number of patients, particularly those who are using opioids in a hazardous manner. Few treatment options are available that target both pain-related interference and hazardous opioid use among patients with chronic pain. In military Veterans, this issue is of particular importance as numerous reports indicate continued high rates of opioid prescription for chronic pain, as well as significant opioid-related problems. The overall aim of the present study was to determine the feasibility of an integrated psychosocial treatment in Veterans with chronic pain, who also have evidence of hazardous opioid use. To examine this aim, a random design was used to assess the feasibility and initial efficacy of integrating 2 empirically supported interventions: Acceptance and Commitment Therapy for chronic pain and Mindfulness Based Relapse Prevention for opioid misuse. Half of participants were randomized to the integrated treatment group and all participants received usual care through a Veteran's Administration co-occurring disorders medical clinic to treat chronic pain and opioid misuse. In total, 37 participants were randomized and included in intent-to-treat analyses and 32 individuals were included in per protocol analyses with 6-month follow-up serving as the primary study endpoint. Feasibility indicators included recruitment, retention, and treatment completion rates. Recruitment fell short of targeted enrollment, although retention and completion were excellent. Primary outcome measures were opioid misuse, pain interference, and pain behavior. Simultaneous multiple regression analyses controlled for pain duration, baseline opioid dose, and baseline value for outcome measures. Results of both the intent-to-treat and per protocol indicated a significant effect in favor of the integrated intervention for opioid misuse, pain interference, and pain behavior. Results support the feasibility of providing an integrated treatment for both opioid risk and pain interference. PERSPECTIVE: Opioid misuse occurs in some opioid-prescribed individuals with chronic pain. Few treatment options exist that target both pain interference and opioid misuse. This study examined feasibility and initial efficacy of an integrated behavioral treatment for Veterans. Feasibility was supported, except recruitment. Efficacy was supported compared to usual care.
慢性疼痛的阿片类药物处方很常见，会使相当数量的患者，特别是以危险方式使用阿片类药物的患者，面临更高的发病率和死亡率。针对慢性疼痛患者的疼痛相关障碍和危险阿片类药物使用，可用的治疗选择很少。在退伍军人中，这个问题尤其重要，因为许多报告表明，继续为慢性疼痛开具阿片类药物处方的比例很高，阿片类药物相关问题也很严重。本研究的总体目标是确定对有慢性疼痛且有危险阿片类药物使用证据的退伍军人进行综合心理社会治疗的可行性。为了检验这一目标，采用随机设计评估了整合两种经验支持的干预措施的可行性和初步疗效：慢性疼痛的接受与承诺治疗和阿片类药物滥用的基于正念的复发预防。一半参与者被随机分配到综合治疗组，所有参与者都通过退伍军人事务部共病医学诊所接受常规护理，以治疗慢性疼痛和阿片类药物滥用。共有 37 名参与者被随机分配，并进行意向治疗分析，32 名参与者进行方案治疗分析，以 6 个月随访作为主要研究终点。可行性指标包括招募、保留和治疗完成率。尽管保留和完成率很高，但招募人数低于目标人数。主要结果测量指标是阿片类药物滥用、疼痛干扰和疼痛行为。同时进行的多元回归分析控制了疼痛持续时间、基线阿片类药物剂量和结果测量的基线值。意向治疗和方案治疗的分析结果都表明，综合干预对阿片类药物滥用、疼痛干扰和疼痛行为有显著的有利影响。结果支持为同时存在阿片类药物风险和疼痛干扰的患者提供综合治疗的可行性。观点：慢性疼痛的阿片类药物处方很常见，会使相当数量的患者，特别是以危险方式使用阿片类药物的患者，面临更高的发病率和死亡率。针对慢性疼痛患者的疼痛相关障碍和危险阿片类药物使用，可用的治疗选择很少。本研究检查了退伍军人综合行为治疗的可行性和初步疗效。除了招募，可行性得到了支持。与常规护理相比，疗效得到了支持。
