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 propose to develop, 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. To our knowledge, the planned program will be the first interactive, web- based program to provide comprehensive, psychosocial treatment to this population.
The specific aims are:
Aim 1 : Develop an interactive, computer-delivered psychosocial treatment for chronic pain patients with aberrant drug-related behavior. We will modify the content of our previously developed and evaluated Therapeutic Education System (TES), a web-based computer-delivered therapy program for individuals with substance use disorders of demonstrated efficacy, to be appropriate for a population of chronic pain patients. The planned TES program will consist of 24 modules and will be 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 will determine 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.
AIM 2 : Evaluate the efficacy of the computer-delivered intervention with chronic pain patients with aberrant drug-related behavior in outpatient treatment for chronic pain. Chronic pain patients 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.
AIM 3 : Examine two therapeutic mechanisms hypothesized to mediate the relationship between the CBT TES intervention and behavioral outcomes: (1) cognitive distortions (e.g., helplessness) relevant to effective pain management and coping and;(2) expectations about the future. This proposed web-based intervention has the potential to markedly improve the treatment of chronic pain by enabling widespread access to evidence-based CBT for chronic pain. Abstract for Web-based CBT for pain grant-FINAL.doc

Public Health Relevance

It is conservatively estimated that 30-60 million Americans experience non-trivial chronic pain and that this disorder imposes substantial personal burden in terms of disability and suffering and incurs significant economic and social costs, such as employee absenteeism and high health care utilization. To address this public health concern, we propose to develop a novel interactive, web-based program to provide comprehensive, psychosocial treatment to opioid-treated, chronic pain patients with aberrant drug-taking behavior. The proposed research will contribute new empirical information relevant to improving the treatment of chronic pain by enabling the widespread delivery of evidence-based psychosocial treatment to chronic pain patients.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZRG1-RPHB-A (03))
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Aklin, Will
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National Development & Research Institutes
New York
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