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Web-based CBT for Opioid-treated, Chronic Pain Patients with Aberrant Behavior

Funding Source

NIDA, R01DA026887

Project Period

6/8/10 - 3/31/16

Principal Investigator

Lisa A. Marsch, PhD; Andrew Rosenblum, PhD

Other Project Staff

Sarah Moore, PhD; Honoria Guarino, PhD; Michelle Acosta, PhD; Russell Portenoy, MD; Ricardo Cruciani, MD; Dennis Turk, PhD; Steve Passik, PhD; Cassandra Melnikow, MA

Project Summary

Although opioid therapy has gained increasing acceptance as a treatment for patients with chronic non-malignant pain (CNMP), concerns persist related to achievement of treatment goals (reduction in pain severity and pain interference) and medication misuse/abuse within the clinical context (often described as aberrant drug related behavior). Psychosocial approaches (particularly self-management strategies such as cognitive-behavior therapy [CBT]) have been found to be efficacious for the treatment of CNMP. However, most chronic pain patients are not exposed to comprehensive psychosocial interventions, largely due to the lack of expertise and time among physicians who prescribe opioids.

To address this public health concern, we have developed and will implement and evaluate an innovative CBT intervention for the treatment of chronic pain tailored to the specific needs of patients who are being prescribed opioids and who present with aberrant behaviors. The program is theoretically grounded in the cognitive-behavioral perspective, incorporating a set of techniques that have been shown to be effective for chronic pain patients with adaptations from the substance abuse literature. Through an iterative development process with both expert consultants and chronic pain patients, we have determined how to best present the information in the program and assess each module’s acceptability, ease of use, likeability, helpfulness, and relevance to the experience of chronic pain patients.

We will evaluate the effectiveness of the web-based intervention with chronic pain patients with aberrant drug-related behavior in outpatient treatment for chronic pain. Chronic pain patients (at the Department of Pain Medicine at Beth Israel Medical Center) will be randomized to receive either: (1) treatment as usual (TAU; n=55); or (2) TAU plus the computer-delivered psychosocial intervention (n=55). Primary outcomes are pain severity, pain interference behaviors, and drug-related aberrant behavior; secondary outcomes include substance misuse, other pain behaviors, and physical and emotional functioning. We will also examine several therapeutic mechanisms hypothesized to mediate the relationship between the CBT web-based intervention and behavioral outcomes.

Public Health Relevance

To our knowledge, the planned program will be the first interactive, web-based program to provide comprehensive, psychosocial treatment to this population. This program has the potential to markedly improve the treatment of chronic pain by enabling widespread access to evidence-based CBT for chronic pain.