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Web-Based Cognitive Behavior Therapy for Opioid-Treated, Chronic Pain Patients with Aberrant Behavior


Guarino H, Fong C, Marsch LA, et al.


This study compared the effectiveness of treatment as usual (TAU) for chronic pain to a web-based cognitive-behavior therapy (CBT) intervention for self-management of chronic pain (Take Charge of Pain) as an adjunct to TAU for improving pain-related symptoms and aberrant drug-related behavior (ADRB).


Researchers randomized 110 patients with ADRB receiving specialty pain treatment to receive TAU or TAU plus Take Charge of Pain. Take Charge of Pain includes 27 modules completed over 12 weeks (~2 modules/week) addressing chronic pain, CBT skills, opioids, and medication management. At baseline and 4, 8, 12, 16, and 24 weeks, participants completed assessments of pain severity and interference, past 30-day ADRB, pain catastrophizing, and past 30-day pain-related emergency department (ED) visits (past 6 months at baseline).

  • Both groups experienced similar reductions in pain severity and interference over time.
  • Participants who received Take Charge of Pain experienced greater reductions in ADRB, pain catastrophizing, and pain-related emergency department (ED) visits over time compared with those that received TAU alone.
  • Participants who received Take Charge of Pain were more likely to report engaging in CBT skills than those receiving TAU at 16 and 24 weeks.
  • Reductions in ADRB experienced by participants who received Take Charge of Pain were clinically significant, falling below the recommended cut-off for prescription drug use disorder, slightly above the cut-off for clinically significant ADRB.
  • Distress or suffering related to chronic pain may be more realistic targets than pain severity for addressing chronic pain and reducing prescription medication misuse.
  • Future research should explore duration of effects of Take Charge of Pain after termination of web-based treatment.
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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. Pain Medicine. 2018. doi: 10.1093/pm/pnx334