How Effective Is Nondrug Pain Management for Patients With Addiction?

In a new study, researchers from the University of Michigan Medical School show that physicians may be able to take a psychosocial, nondrug approach to treat chronic pain patients who are also dealing with addiction.

Chronic pain, the authors note, is difficult to treat in individuals with substance use disorders and can have a negative impact on substance use disorder treatment outcomes. In order to test the efficacy of a psychosocial pain management intervention, the researchers conducted a randomized, controlled trial comparing ImPAT (improving pain during addiction treatment), which combines pain management with content related to managing pain without substance use, to a supportive psychoeducational control (SPC) condition in 129 Veterans Health Administration patients.
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Follow-up assessments occurred at 3, 6, and 12 months. Pain intensity was the primary measurement over 12 months, in addition to pain-related functioning, and frequency of alcohol and drug use over the
same span.

Patients receiving pain-focused care while being treated for addition saw both pain intensity and alcohol use decrease, while reporting that their ability to function increased. Both groups, however, had similar rates of drug use.

Clinicians should be aware that patients do not always sort themselves into only those with legitimate pain versus those who are primarily motivated by addiction," says lead study author Mark Ilgen, PhD, an associate professor in the department of psychiatry at the University of Michigan Medical School.

"Treatment providers will want to assess for pain and alcohol or drug use, and look for treatment options that address both domains," said Dr Ilgen, adding that a combination of medication-based and nonpharmacologic approaches are likely to work best to improve functioning in complicated patients with co-occurring pain and addiction.

While this study focused on a psychotherapeutic approach, other potentially helpful options include physical therapy and exercise, he said.

"Because of the complexity of managing both pain and addiction, primary care practitioners may want to make multiple referrals to pain specialists," concluded Dr Ilgen, "as well as addiction treatment programs."

—Mark McGraw

Reference:

Ilgen MA, Bohnert ASB, Chermack S, et al. A randomized trial of a pain management intervention for adults receiving substance use disorder treatment. Addiction. 2016;111(8):1385-1393.