Training Addiction Counselors to Deliver A Brief Psychoeducational Intervention for Chronic Pain among Patients in Opioid Agonist Treatment: A Pilot Investigation
Restricted accessResearch articleFirst published online April, 2018
Training Addiction Counselors to Deliver A Brief Psychoeducational Intervention for Chronic Pain among Patients in Opioid Agonist Treatment: A Pilot Investigation
Despite high rates of chronic pain among their patients, opioid agonist treatment (OAT) counselors report an absence of training to manage chronic pain.
Methods
A multidisciplinary team developed a tailored training for counselors to screen and address chronic pain via a brief psychosocial intervention, and implemented it with 52 addiction counselors. Data on knowledge (9 true-false items) as well as attitudes, interest, and perceived ability (scored on 5-point Likert-type scales) were collected from counselors before (pre-test), after (post-test) training, and after 6 months (follow-up).
Results
Pre-test knowledge scores varied considerably. Compared to pre-test, mean counselor knowledge scores increased significantly post-training and at follow-up (p's.<05). The training was associated with increases in positive attitudes toward the role of counselors in managing chronic pain, interest in assessing chronic pain, and counselor ability to assess as well as suggest appropriate interventions for pain (all p's <.05). Perceived ability to assess chronic pain and suggest appropriate treatment interventions were higher at follow-up than at pre-test (p's <.05).
Conclusions
Findings related to the initial evaluation of this training were promising, and future research is warranted to further examine the efficacy of training drug counselors on psychosocial interventions to manage chronic pain among OAT patients.
VolkowND, McLellanAT. Opioid abuse in chronic pain—misconceptions and mitigation strategies. N Engl J Med. 2016;374(13):1253–1263.
2.
NielsenS, LaranceB, DegenhardtL, GowingL, LintzerisN. A systematic review of opioid agonist treatments for pharmaceutical opioid dependence. Drug & Alcohol Dependence. 2017;171:e152–e153.
3.
BarryDT, BeitelM, JoshiD, SchottenfeldRS. Pain and substance-related pain reduction behaviors among opioid dependent individuals seeking methadone maintenance treatment. Am J Addict. 2009;18(2):117–121.
4.
DhingraL, MassonC, PerlmanDC, . Epidemiology of pain among outpatients in methadone maintenance treatment programs. Drug Alcohol Depend. 2013;128:161–165.
5.
RosenblumA, JosephH, FongC, KipnisS, ClelandC, PortenoyRK. Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. JAMA. 2003;289(18):2370–2378.
6.
JamisonRN, KauffmanJ, KatzNP. Characteristics of methadone maintenance patients with chronic pain. J Pain Symptom Manage. 2000;19(1):53–62.
7.
BarryDT, SavantJD, BeitelM, . Pain and associated substance use among opioid dependent individuals seeking office-based treatment with buprenorphine-naloxone: a needs assessment study. Am J Addict. 2013;22:212–217.
8.
BarryDT, BeitelM, CutterCJ, JoshiD, FalcioniJ, SchottenfeldRS. Conventional and Nonconventional Pain Treatment Utilization Among Opioid Dependent Individuals With Pain Seeking Methadone Maintenance Treatment: A Needs Assessment Study. J Addict Med. 2010;4(2):81–87.
9.
BarryDT, SavantJD, BeitelM, . Use of conventional, complementary, and alternative treatments for pain among individuals seeking primary care treatment with buprenorphine-naloxone. J Addict Med. 2012;6(4):274–279.
BeitelM, OberleitnerL, KahnM, . Drug counselor responses to patients’ pain reports: A qualitative investigation of barriers and facilitators to treating patients with chronic pain in methadone maintenance treatment. Pain Med. 2017;pnw327. doi: 10.1093/pm/pnw327.
12.
BergKM, ArnstenJH, SacajiuG, KaraszA. Providers’ experiences treating chronic pain among opioid-dependent drug users. J Gen Intern Med. 2009;24(4):482–488.
13.
BarryDT, CutterCJ, BeitelM, KernsRD, LiongC, SchottenfeldRS. Psychiatric disorders among patients seeking treatment for co-occurring chronic pain and opioid use disorder. J Clin Psychiatry. 2016;77(10):1413–1419.
14.
WachholtzA, GonzalezG, BoyerE, NaqviZ, RosenbaumC, ZiedonisD. Intersection of chronic pain treatment and opioid analgesic misuse: Causes, treatments, and policy strategies. Subst Abus. 2011;2:145–162.
15.
AlfordDP, BarryDT, FiellinDA. Treating pain in patients receiving methadone maintenance for opioid dependence. In: CrucianiR, KnotkovaH, eds. Handbook of Methadone Prescribing and Buprenorphine Therapy. New York: Springer; 2013:31–37.
16.
BarryDT, SavantJD, BeitelM, . The feasibility and acceptability of groups for pain management in methadone maintenance treatment. J Addict Med. 2014;8(5):338–344.
17.
Substance Abuse and Mental Health Services Administration. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. SMA 07–3939. Rockville, MD2005:04–3939.
18.
Substance Abuse and Mental Health Services Administration. Managing Chronic Pain in Adults with or in Recovery from Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 54. HHS Publication No. (SMA) 12–4671. Rockville, MD2011.
19.
ChouR, DeyoR, FriedlyJ, . Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice GuidelineNonpharmacologic Therapies for Low Back Pain. Ann Intern Med. 2017.
20.
DowellD, HaegerichTM, ChouR. CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA. 2016;315(15):1624–1645.
21.
AngstF, AngstJ, Ajdacic-GrossV, AeschlimannA, RösslerW. Epidemiology of back pain in young and middle-aged adults: A longitudinal population cohort survey from age 27 to 50 years. Psychosomaticshttps://doiorg/101016/jpsym201705004. 2017.
22.
ChouR, HuffmanLH. Nonpharmacologic therapies for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):492–504.
23.
KernsRD, SellingerJ, GoodinBR. Psychological treatment of chronic pain. Annu Rev Clin Psychol. 2011;7:411–434.
24.
RoditiD, RobinsonME. The role of psychological interventions in the management of patients with chronic pain. Psychol Res Behav Manag. 2011;4:41–49.
25.
DowdH, HoganMJ, McGuireBE, . Comparison of an online mindfulness-based cognitive therapy intervention with online pain management psychoeducation: a randomized controlled study. Clin J Pain. 2015;31(6):517–527.
26.
GatchelRJ, McGearyDD, McGearyCA, LippeB. Interdisciplinary chronic pain management: Past, present, and future. Am Psychol. 2014;69(2):119.
27.
MeeusM, NijsJ, Van OosterwijckJ, Van AlsenoyV, TruijenS. Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial. Arch Phys Med Rehabil. 2010;91(8):1153–1159.
28.
VlaeyenJW, LintonSJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain. 2000;85(3):317–332.
29.
OberleitnerL, BeitelM, SchottenfeldRS, . Drug counselors’ attitudes toward non-pharmacologic treatments for chronic pain. J Addict Med. 2016;10:34–39.
30.
TaubenDJ, LoeserJD. Pain education at the University of Washington School of Medicine. J Pain. 2013;14(5):431–437.
31.
BementMKH, SlukaKA. The current state of physical therapy pain curricula in the United States: A faculty survey. J Pain. 2015;16(2):144–152.
32.
FishmanSM, YoungHM, Lucas ArwoodE, . Core competencies for pain management: results of an interprofessional consensus summit. Pain Med. 2013;14(7):971–981.
33.
DoorenbosAZ, GordonDB, TaubenD, . A blueprint of pain curriculum across prelicensure health sciences programs: One NIH Pain Consortium Center of Excellence in Pain Education (CoEPE) experience. J Pain. 2013;14(12):1533–1538.
34.
FieldsHL. Core curriculum for professional education in pain, Rev. IASP press; 1991.
35.
BriggsEV, CarrlEC, WhittakerlMS. Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. Eur J Pain. 2011;15(8):789–795.
36.
CarrDB, BradshawYS. Time to flip the pain curriculum? Anesthesiology: The Journal of the American Society of Anesthesiologists. 2014;120(1):12–14.
37.
LoeserJD, SchatmanME. Chronic pain management in medical education: A disastous omission. Postgrad Med. 2017;129:332–335.
38.
CleelandCS. Pain assessment in cancer. In: OsabaD, ed. Effect of cancer on quality of life. Boca Raton, FL: CRC Press; 1991:293–305.
39.
BeitelM, Stults‐KolehmainenM, CutterCJ, . Physical activity, psychiatric distress, and interest in exercise group participation among individuals seeking methadone maintenance treatment with and without chronic pain. Am J Addict. 2016;25(2):125–131.
40.
OtisJD. Cognitive behavioral therapy for the treatment of chronic pain: therapist's manual. Pain Management Program, VA Boston: Healthcare System; 2005.
41.
EcclestonC, AdCWilliams, MorleyS. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2009;2.
42.
BarlowJ, WrightC, SheasbyJ, TurnerA, HainsworthJ. Self-management approaches for people with chronic conditions: A review. Patient Educ Couns. 2002;48(2):177–187.
