CBT Helps High-Risk Patients Taper off Opioids
Boschert, Sherry, Clinical Psychiatry News
FROM THE ANNUAL MEETING OF THE AMERICAN ACADEMY OF PAIN MEDICINE
PALM SPRINGS, CALIF. -- An intensive interdisciplinary outpatient program successfully treated 246 patients at high risk of substance abuse, alongside 230 low-risk patients, for their debilitating chronic pain.
At the start of the 3-week pain rehabilitation program, the two groups did not differ significantly in their duration of pain (nearly 12 years on average) or duration of opioid use (6 years on average). They reported similar levels of pain severity.
The high-risk patients, however, had significantly worse scores on measures of depression, pain interference with life. pain catastrophizing, and perceived control of life and pain. Despite comparable pain severity and duration, they were taking significantly greater morphine-equivalent doses of pain medications, compared with doses taken by low-risk patients (124 vs. 60 mg/day).
By the end of the program, which incorporated substance abuse education and support, both the high-risk and low-risk groups had improved in all these measures, and there was no longer any significant difference in scores between the two groups, Sarah E. Hayes reported in an award-winning poster and plenary session at the meeting.
The intensive program at the Mayo Clinic, Rochester, Minn. provides more than can be offered in a typical ambulatory setting, coinvestigator Dr. Michael Hooten said in an interview. The results suggest that high-risk patients can be included in pain rehabilitation programs without affecting treatment outcomes, said Dr. Hooten of the Mayo Clinic.
Patients attend sessions 8 hours per day, 5 days per week, focused on functional restoration, withdrawal from opioids, and reduced polypharmacy rather than on attempted cures or interventional procedures for their chronic pain. Approximately 97% completely taper off of opioids, said Ms. Hayes, who conducted the study while she was a research associate at the Mayo Clinic and is now a student at New York University.
The interdisciplinary staff includes physicians, psychologists, pharmacists, nurses, physical therapists, and occupational therapists. The foundation of treatment is a cognitive-behavioral model that includes biofeedback, relaxation training, and stress management. Padents receive education in "chemical health" and in "wellness" topics such as sleep hygiene and healthy diets. Pain management training covers activity moderation and eliminating behaviors that cause pain. Family education and after-care assistance are provided.
Patients were identified as high risk if they had a history of using mood-al-tering substances, used pain medications in ways other than those prescribed, showed aberrant drug-related behaviors, had family members or health care providers who expressed concern, had a family history of substance abuse, or had other health risks (such as polypharmacy and high-dose opioid use). …