Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

CDA 13-268 – HSR&D Study

New | Current | Completed | DRA | DRE | Portfolios/Projects | Centers | Career Development Projects

CDA 13-268
Chronic Pain Management in Veterans with Co-occurring Substance Use Disorders
Travis I. Lovejoy PhD MPH
VA Portland Health Care System, Portland, OR
Portland, OR
Funding Period: November 2014 - October 2019

BACKGROUND/RATIONALE:
Chronic non-cancer pain (CNCP) is a significant public health burden and is more pronounced in Veterans with histories of a substance use disorder (SUD). Evidence-based clinical guidelines call for the use of multimodal pain treatments that address the biological, psychological, and social needs of patients with CNCP, yet Veterans with co-occurring CNCP and SUD face many barriers to the receipt of guideline-concordant pain care. Specialty SUD treatment programs may be optimally positioned to provide pain treatment for Veterans with co-occurring CNCP and SUD.

OBJECTIVE(S):
The research objectives of this study are to (1) characterize pain treatment utilization following initiation of specialty SUD treatment in the VA nationally, (2) identify patient and organizational preferences and characteristics that will inform tailoring of an evidence based primary care collaborative pain intervention (CPI) for a specialty SUD treatment setting, and (3) pilot test the CPI in one VA Medical Center.

METHODS:
This study is guided by the VA Quality Enhancement Research Initiative (QUERI) and Glasgow's Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) frameworks of implementing empirically-supported interventions into clinical practice. Objective 1 will utilize national VA administrative data to examine pain treatment utilization in Veterans with co-occurring chronic non-cancer pain (CNCP) and SUD. Objective 2 will involve the conduct of qualitative interviews with Veterans, SUD treatment staff and managers, primary care providers, and hospital administrators to identify barriers and facilitators to implementation of an evidence based primary care CPI within a specialty SUD treatment clinic. These data will inform tailoring of the CPI to increase implementation likelihood within the SUD treatment clinic. For Objective 3, we will conduct a single-group pilot feasibility trial of the CPI in a specialty SUD treatment clinic of one VA Medical Center.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Approximately 500,000 Veterans receiving care through VHA have a SUD diagnosis, and a significant proportion of these Veterans experience chronic pain. Results from the proposed studies will inform future lines of programmatic research that will identify best practices for the treatment of CNCP in Veterans with comorbid SUD and implementation of these treatment modalities into the VA healthcare system. This has great potential to improve physical and mental health functioning, decrease substance use and abuse, and increase quality of life for tens of thousands of Veterans.

PUBLICATIONS:

Journal Articles

  1. McPherson S, Lederhos Smith C, Dobscha SK, Morasco BJ, Demidenko MI, Meath THA, Lovejoy TI. Changes in pain intensity after discontinuation of long-term opioid therapy for chronic noncancer pain. Pain. 2018 Oct 1; 159(10):2097-2104.
  2. Lovejoy TI, Morasco BJ, Demidenko MI, Meath THA, Dobscha SK. Clinician Referrals for Non-opioid Pain Care Following Discontinuation of Long-term Opioid Therapy Differ Based on Reasons for Discontinuation. Journal of general internal medicine. 2018 May 1; 33(Suppl 1):24-30.
  3. Frank JW, Lovejoy TI, Becker WC, Morasco BJ, Koenig CJ, Hoffecker L, Dischinger HR, Dobscha SK, Krebs EE. Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review. Annals of internal medicine. 2017 Aug 1; 167(3):181-191.
  4. Demidenko MI, Dobscha SK, Morasco BJ, Meath THA, Ilgen MA, Lovejoy TI. Suicidal ideation and suicidal self-directed violence following clinician-initiated prescription opioid discontinuation among long-term opioid users. General hospital psychiatry. 2017 Jul 1; 47:29-35.
  5. Lovejoy TI, Morasco BJ, Demidenko MI, Meath TH, Frank JW, Dobscha SK. Reasons for discontinuation of long-term opioid therapy in patients with and without substance use disorders. Pain. 2017 Mar 1; 158(3):526-534.
  6. Feldstein Ewing SW, Lovejoy TI, Choo EK. How Has Legal Recreational Cannabis Affected Adolescents in Your State? A Window of Opportunity. American journal of public health. 2017 Feb 1; 107(2):246-247.
  7. Morasco BJ, Greaves DW, Lovejoy TI, Turk DC, Dobscha SK, Hauser P. Development and Preliminary Evaluation of an Integrated Cognitive-Behavior Treatment for Chronic Pain and Substance Use Disorder in Patients with the Hepatitis C Virus. Pain medicine (Malden, Mass.). 2016 Dec 1; 17(12):2280-2290.
  8. Choo EK, Feldstein Ewing SW, Lovejoy TI. Opioids Out, Cannabis In: Negotiating the Unknowns in Patient Care for Chronic Pain. JAMA. 2016 Nov 1; 316(17):1763-1764.
  9. Dobscha SK, Lovejoy TI, Morasco BJ, Kovas AE, Peters DM, Hart K, Williams JL, McFarland BH. Predictors of Improvements in Pain Intensity in a National Cohort of Older Veterans With Chronic Pain. The journal of pain : official journal of the American Pain Society. 2016 Jul 1; 17(7):824-35.
  10. Heckman TG, Heckman BD, Anderson T, Lovejoy TI, Markowitz JC, Shen Y, Sutton M. Tele-Interpersonal Psychotherapy Acutely Reduces Depressive Symptoms in Depressed HIV-Infected Rural Persons: A Randomized Clinical Trial. Behavioral Medicine (Washington, D.C.). 2017 Oct 1; 43(4):285-295.
  11. Lovejoy TI, Dobscha SK, Turk DC, Weimer MB, Morasco BJ. Correlates of prescription opioid therapy in Veterans with chronic pain and history of substance use disorder. Journal of rehabilitation research and development. 2016 Feb 1; 53(1):25-36.
  12. Adams MH, Lovejoy TI, Turk DC, Dobscha SK, Hauser P, Morasco BJ. Pain-related anxiety mediates the relationship between depressive symptoms and pain interference in veterans with hepatitis C. General hospital psychiatry. 2015 Nov 1; 37(6):533-7.
  13. Lovejoy TI, Heckman TG, Sikkema KJ, Hansen NB, Kochman A. Changes in sexual behavior of HIV-infected older adults enrolled in a clinical trial of standalone group psychotherapies targeting depression. AIDS and behavior. 2015 Jan 1; 19(1):1-8.
  14. Morasco BJ, Lovejoy TI, Turk DC, Crain A, Hauser P, Dobscha SK. Biopsychosocial factors associated with pain in veterans with the hepatitis C virus. Journal of behavioral medicine. 2014 Oct 1; 37(5):902-11.
Journal Other

  1. Lovejoy TI, Dobscha SK, Morasco BJ, Smith CL, Meath T, Demidenko M, McPherson S. Changes in pain intensity following discontinuation of long-term opioid therapy. [Abstract]. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2018 Apr 11; 52(1):S165.
  2. Lovejoy TI, Morasco BJ, Dobscha SK, Wyse JJ, Meath T. Pain care utilization following episodes of specialty substance use disorder treatment. [Abstract]. The journal of pain : official journal of the American Pain Society. 2018 Mar 1; 19(3):S21.
  3. Lovejoy TI, Demidenko MI, Morasco BJ, Meath T, Dobscha SK. Suicidal ideation and behaviors following clinician-initiated prescription opioid discontinuation among long-term opioid users. [Abstract]. The journal of pain : official journal of the American Pain Society. 2017 Apr 1; 18(4):S36.
  4. Diulio AR, Demidenko MI, Lovejoy TI. Multidisciplinary pain clinics, in Treating comorbid opioid use disorder and dependence in chronic pain. Ed. Matthews, AM. Springer International Publishing, 2016: pp. 177-184. SpringerPlus. 2016 Apr 30.
  5. Dobscha SK, Lovejoy TI, Morasco BJ, Kovas AE, Peters D, Williams J, McFarland B. Predictors of Improvement in Pain Intensity in Older Veterans with Chronic Pain: National Cohort Study. [Abstract]. Pain. 2016 Apr 26; 17(4):S87-S87.
  6. Lovejoy TI, Morasco BJ, Demidenko MI, Meath TH, Frank JW, Dobscha SK. Reasons for discontinuation of long-term opioid therapy in patients with and without substance use disorders. [Abstract]. Pain. 2016 Apr 1; 17(4):s87.
  7. Lovejoy TI, Dobscha SK, Turk DC, Weimer MB, Morasco BJ. Predictors of prescription opioid therapy in patients with chronic pain and a history of substance use disorder. [Abstract]. The journal of pain : official journal of the American Pain Society. 2015 Apr 1; 16(1):S84.
  8. Morasco BJ, Greaves DW, Lovejoy TI, Turk DC, Dobscha SK, Hauser P. Development and preliminary evaluation of an integrated cognitive-behavior treatment for patients with the hepatitis C virus who have comorbid chronic pain and substance use disorder. [Abstract]. The journal of pain : official journal of the American Pain Society. 2015 Apr 1; 16(1):S98.
HSR&D or QUERI Publications

  1. Lovejoy TI. Discontinuation of Long-Term Opioid Therapy among Veterans is Overwhelmingly Initiated by VA Clinicians. 2017 Jul 1.
VA Cyberseminars

  1. Becker W, Lovejoy TI. Opioid dose reduction in patients prescribed long-term opioid therapy for chronic pain. HSR&D Career Development Award Enhancement Initiative [Cyberseminar]. VA HSR&D. 2017 Jul 26.
Conference Presentations

  1. Lovejoy TI, Demidenko MI. A pilot study of group Acceptance and Commitment Therapy for chronic pain in patients with comorbid substance use disorders. Poster session presented at: American Psychological Association Annual Convention; 2016 Aug 4; Denver, CO.
  2. Frank JW, Lovejoy TI, Becker W, Morasco BJ, Koenig CJ, Dischinger HR, Dobscha SK, Krebs EE. Dose Reduction and Discontinuation of Long-Term Opioid Therapy: A Systematic Review. Paper presented at: Society of General Internal Medicine Annual Meeting; 2016 May 11; Hollywood, FL.
  3. Dobscha SK, Lovejoy TI, Morasco BJ, Kovas AE, Peters DM, Hart K, Williams JL, McFarland BH. Predictors of Improvement in Pain Intensity in Older Veterans with Chronic Pain: National Cohort Study. Poster session presented at: American Pain Society Annual Meeting; 2016 May 2; Austin, TX.
  4. Lovejoy TI, Morasco BJ, Demidenko MI, Meath TH, Dobscha SK. Reasons for discontinuation of long-term opioid therapy in patients with and without substance use disorders. Poster session presented at: American Pain Society Annual Meeting; 2016 May 2; Austin, TX.
  5. Lovejoy TI. Telephone interventions to target depression in people living with HIV. Presented at: Ontario HIV Treatment Network Northern Exposures: A Research and Practice Conference; 2015 Nov 4; Dryden, Canada.
  6. Lovejoy TI. Telephone group mental health interventions for HIV-positive older adults. Presented at: Ontario HIV Treatment Network Northern Exposures: A Research and Practice Conference; 2015 Nov 4; Dryden, Canada.
  7. Ono SS, Lovejoy TI, Carlson KF, Cottrell EK, O'Neil ME. Establishing a Veterans Advisory Council to Empower Patients and Inform VA Health Services Research. Paper presented at: Society for Implementation Research Collaboration Biennial Conference on Advancing Efficient Methodologies Through Community Partnerships and Team Science; 2015 Sep 25; Seattle, WA.
  8. Lovejoy TI. VA Mobile Health Applications in Clinical Practice. Paper presented at: American Psychological Association Annual Convention; 2015 Aug 8; Toronto, Canada.
  9. Lovejoy TI, Meath THA, Morasco BJ, Demidenko MI, Dobscha SK. Changes in pain intensity and pain treatment utilization in Veterans following discontinuation of long-term opioid therapy. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  10. Plagge J, Lu M, Lovejoy T, Karl A, Dobscha SK. Treatment of Comorbid Pain and PTSD in Returning Veterans: A Collaborative Care Approach Utilization Behavioral Activation. Poster session presented at: Academy of Psychosomatic Medicine Annual Meeting; 2013 Nov 14; Tucson, AZ.


DRA: Substance Abuse and Addiction, Health Systems
DRE: Technology Development and Assessment
Keywords: Substance Use and Abuse
MeSH Terms: none