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2015 HSR&D/QUERI National Conference Abstract

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1024 — The Efficacy of Non-Pharmacologic Pain Management for Veterans Receiving Substance Use Disorder Treatment

Ilgen MA, Ann Arbor COIN; Bohnert AS, Ann Arbor COIN;

Objectives:
Chronic pain is common among Veterans with substance use disorders, and is challenging to treat in the context of comorbid substance use disorders. When not resolved, chronic pain can have a negative impact on substance use disorder treatment outcomes. The objective of this randomized controlled trial was to examine the impact of a psychosocial pain management intervention on pain and substance use outcomes among Veterans with significant pain engaged in addictions treatment.

Methods:
Participants with co-occurring chronic pain and substance use disorders were identified during an episode of VA substance use disorder treatment and randomized to either an intervention (referred to as ImPAT) that combined cognitive behavioral and acceptance-based therapies to address co-occurring pain and substance use or a supportive psycho-educational control (SPC) condition. Both conditions involved 10 weekly group sessions led by study therapists. Participants were followed at 3-, 6-, and 12-months after baseline.

Results:
Over the 12-months of follow-up, randomization to the ImPAT intervention predicted significantly lower pain level [ß(se) = -0.65(0.29); p < 0.05)], improved pain-related functioning [ß(se) = 0.25 (0.11); p < 0.05] and lower frequency of alcohol consumption [ß(se) = -0.77 ; p < 0.05]. No differences were seen between conditions on frequency of drug use over follow-up. Analyses also indicate that the ImPAT condition resulted in greater self-efficacy to manage pain without substance use than the SPC condition [ß(se) = 10.28(3.24); p < 0.05].

Implications:
A non-pharmacological pain management intervention significantly improved pain- and alcohol-related outcomes over 12-months.

Impacts:
The present findings indicate that augmenting addictions treatment with psychosocial pain management approaches for patients with chronic pain can lead to better long-term outcomes. Adding these services to VA substance use disorder programs has the potential to improve care for this difficult-to-treat group of Veterans.