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A randomized trial of a pain management intervention for adults receiving substance use disorder treatment.

Ilgen MA, Bohnert AS, Chermack S, Conran C, Jannausch M, Trafton J, Blow FC. A randomized trial of a pain management intervention for adults receiving substance use disorder treatment. Addiction (Abingdon, England). 2016 Aug 1; 111(8):1385-93.

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BACKGROUND AND AIMS: Chronic pain is difficult to treat in individuals with substance use disorders and, when not resolved, can have a negative impact on substance use disorder treatment outcomes. This study tested the efficacy of a psychosocial pain management intervention, ImPAT (improving pain during addiction treatment), that combines pain management with content related to managing pain without substance use. DESIGN: Single-site, parallel-groups randomized controlled trial comparing ImPAT to a supportive psychoeducational control (SPC) condition; follow-up assessments occurred at 3, 6 and 12 months. SETTING: The Ann Arbor VA Substance Use Disorder treatment program, USA. PARTICIPANTS: Veterans Health Administration patients {n  =  129; mean [standard deviation (SD)], age  =  51.7 (9.5); 115 of 129 (89%) male; ImPAT (n  =  65); SPC (n  =  64)}. INTERVENTION: ImPAT combines principles of cognitive-behavioral therapy and acceptance-based approaches to pain management with content related to avoiding the use of substances as a coping mechanism for pain. The SPC used a psychoeducational attention control treatment for alcoholism modified to cover other substances in addition to alcohol. MEASUREMENTS: Primary: Pain intensity over 12 months; secondary: pain-related functioning, frequency of alcohol and drug use over 12 months. FINDINGS: Primary: randomization to the ImPAT intervention versus SPC predicted significantly lower pain intensity {ß [standard error (SE)]  =  -0.71 (0.29); 95% confidence interval (CI)  =  -1.29, -0.12}; secondary: relative to the SPC condition, those who received ImPAT also reported improved pain-related functioning [ß (SE)  =  0.27 (0.11); 95% CI  =  0.05, 0.49] and lower frequency of alcohol consumption [ß (SE)  =  -0.77; 95% CI  =  -1.34, -0.20]. No differences were found between conditions on frequency of drug use over follow-up. CONCLUSIONS: For adults with pain who are enrolled in addictions treatment, receipt of a psychological pain management intervention (improving pain during addiction treatment) reduced pain and alcohol use and improves pain-related functioning over 12 months relative to a matched-attention control condition.

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