Guarino H, Fong C, Marsch L, et al. (2018). Web-based cognitive behavior therapy for chronic pain patients with aberrant drug-related behavior: Outcomes from a randomized controlled trial. Pain Medicine. 19(12): 2423–2437. doi: 10.1093/pm/pnx334
Researchers recruited adults with chronic pain and aberrant drug-related behavior (ADRB) (n = 110) to participate in a comparison of the effectiveness of treatment as usual (TAU) and a web-based intervention (Take Charge of Pain: TCP) for improving pain-related symptoms and ADRB. Recruitment occurred through provider referral, study fliers, and staff outreach at a large pain treatment practice in New York City, where all participants had been receiving long-term opioid therapy. Researchers randomized participants to receive TAU (n = 55) or TAU plus TCP (n = 55). TCP included 27 modules completed over 12 weeks addressing chronic pain, cognitive behavioral therapy (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. Both intervention and TAU alone participants experienced significant reductions in pain severity and pain interference (generally maintained through the follow-ups), however, no significant between-group differences emerged for either outcome. Compared with TAU alone participants, TCP participants reported significantly greater reductions in ADRB, pain catastrophizing, and pain-related ED visits during the intervention period, with results maintained through 24 weeks. Reductions in ADRB experienced by participants who received TCP were clinically significant, with mean opioid misuse measure scores dropping below the threshold of prescription drug use disorder. TCP participants were also significantly more likely than TAU alone participants to use CBT skills at 16 and 24 weeks. Future research could explore the duration of effects of TCP after termination of web-based treatment.