We propose to integrate a chronic pain management program based on cognitive behavioral therapy plus physical therapy (CBT+PT) with addiction treatment and test this package with a population of chronic pain patients addicted to opioid analgesic medications (CPP+OD) who are in residential addiction treatment at the Caron Foundation. The study employs a prospective two-group randomized design, in which subjects will be randomly assigned to receive one of two conditions: Treatment-as-usual (TAU) at Caron plus the integrated CBT-PT program (i.e., CBT-PT), or TAU plus an attention control support group. The baseline assessment will be administered during the first week of treatment, and data on potential mediators and pain levels will be obtained during treatment at weeks 2 and 4. The follow-up will be at 3 months post-discharge, and will provide post-treatment data on substance use, pain, and psychosocial functioning. Approximately 120 subjects will be recruited into the study during a 28- month period. The primary outcome measures will be post-treatment drug use, within- and post-treatment pain levels and mobility, and post-treatment psychosocial functioning. In addition, the study will evaluate the cost-effectiveness of the intervention. This is critical information for treatment programs, policy makers, and third-party payers who may be interested in implementing the intervention. Additional secondary analyses will examine potential mediator effects of changes in depression, anxiety, and acceptance of pain, substance use and pain outcomes. Relevance: The development of an integrated program to address chronic pain, opioid dependence, and psychiatric distress could have substantial benefit to science and to public health. Patients who have co-occurring pain and addictive disorders may have a high vulnerability to relapse to addictive behaviors if their pain is not managed. The results of this study will provide critical treatment and economic information for treatment programs, policy makers, and third-party payers who may be interested in implementing the intervention. This initial test of an evidence-based behavioral intervention for chronic pain will become the basis for future work at Caron to further develop and improve effective approaches to pain management which will have economic benefits to patients and treatment programs that outweigh additional costs.
