Opioid prescription in the treatment of chronic pain is frequent and carries a consequent risk of poor treatment outcome, as well as higher morbidity and mortality in a clinically significant number of patients, particularly those who meet criteria or opioid dependence. Despite the alarming increases (140% increase from 1992 to 2003) in prescription opiate misuse, abuse, and dependence nationally in the United States, there are few treatment options available that target both pain-related interference and opioid dependence among patients with chronic pain. In military veterans, this issue is of particular importance as numerous reports indicate increasing use of opioids in the treatment of chronic pain, as well as increasing opioid-related problems, specifically in those who served in the Iraq and Afghanistan theatres [Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND)]. To date, there are no evidenced-based treatment options which aim to both maximize effective functioning in Veterans with chronic pain while simultaneously addressing problematic opioid use. The overall aim of the present study will be to determine the feasibility of an integrated psychosocial treatment in veterans with chronic pain, who also have evidence of opioid-related misuse. To examine this aim, we will utilize a randomized design to assess the feasibility of integrating two empirically supported interventions: Acceptance and Commitment Therapy for chronic pain and Mindfulness Based Relapse Prevention for substance use and misuse. Feasibility will be assessed by examining rates of recruitment and retention of participants through a six month follow-up. In addition, we will evaluate progress within-treatment on specific therapy targets to aid in the identification of potential treatment mechanisms. The results of this study will directly inform treatment of chronic pain patients and represents a significant advance in the growing and understudied problem of opiate misuse among chronic pain patients. In addition to addressing the question of whether the treatment is feasible, it will further examine issues of treatment mechanisms to better inform the design of a randomized and controlled trial assessing treatment efficacy.

Public Health Relevance

Chronic pain and misuse of opioids is a major public health problem, particularly in military veterans. The major goal of this project is to test the efficacy f an innovative behavioral treatment for chronic pain patients who are misusing prescription opiates. This project supports the strategic goals of NCCAM and NIDA by examining a difficult and understudied problem with the ultimate goal of impacting scientific knowledge and human health.

National Institute of Health (NIH)
National Center for Complementary & Alternative Medicine (NCCAM)
Planning Grant (R34)
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Special Emphasis Panel (ZAT1-HS (15))
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Huntley, Kristen V
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University of New Mexico
Schools of Arts and Sciences
United States
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Vowles, Kevin E; Bailey, Robert W; McEntee, Mindy L et al. (2018) Using Analgesics for Emotional Modulation is Associated With Increased Distress, Depression, and Risk of Opioid and Alcohol Misuse: Initial Evaluation and Component Analysis of the Reasons for Analgesic Use Measure (RAUM). Clin J Pain 34:975-982
Witkiewitz, Katie; Votaw, Victoria R; Vowles, Kevin E et al. (2018) Opioid Misuse as a Predictor of Alcohol Treatment Outcomes in the COMBINE Study: Mediation by Medication Adherence. Alcohol Clin Exp Res 42:1249-1259
Witkiewitz, Katie; Vowles, Kevin E (2018) Alcohol and Opioid Use, Co-Use, and Chronic Pain in the Context of the Opioid Epidemic: A Critical Review. Alcohol Clin Exp Res 42:478-488
Bailey, Robert W; Vowles, Kevin E (2017) Using Screening Tests to Predict Aberrant Use of Opioids in Chronic Pain Patients: Caveat Emptor. J Pain 18:1427-1436
Pielech, Melissa; Vowles, Kevin E; Wicksell, Rikard (2017) Acceptance and Commitment Therapy for Pediatric  Chronic Pain: Theory and Application. Children (Basel) 4:
Witkiewitz, Katie; McCallion, Elizabeth; Vowles, Kevin E et al. (2015) Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect. J Consult Clin Psychol 83:1044-57
Witkiewitz, Katie; Vowles, Kevin E; McCallion, Elizabeth et al. (2015) Pain as a predictor of heavy drinking and any drinking lapses in the COMBINE study and the UK Alcohol Treatment Trial. Addiction 110:1262-71