Cited by 33Substance Abuse Treatment and OutcomesOpioid Use Disorder TreatmentMusculoskeletal pain and rehabilitation

Efficacy of a Psychosocial Pain Management Intervention for Men and Women With Substance Use Disorders and Chronic Pain: A Randomized Clinical Trial

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Ilgen, Mark A., Coughlin, Lara N., Bohnert, Amy S. B., Chermack, Stephen, Price, Amanda, Kim, H. Myra, Jannausch, Mary, Blow, Frederic C.·2020·JAMA Psychiatry

Abstract

Importance: Chronic pain is common in those with substance use disorders (SUDs) and predicts poorer addiction treatment outcomes. A critical challenge for addiction treatment is to develop effective methods to improve pain-related and substance use-related outcomes for those in treatment for SUDs. Objective: To examine the efficacy of an integrated behavioral pain management intervention (Improving Pain During Addiction Treatment [ImPAT]) for men and women with SUDs to treat pain, functioning, and substance use. Design, Setting, and Participants: In this randomized clinical trial, 8 sessions of ImPAT were compared with 8 sessions of a supportive psychoeducational control (SPC) condition for adults with pain treated at a large residential SUD treatment program. Follow-up occurred at 3, 6, and 12 months postbaseline. A total of 1372 adults were screened, including 960 men and 412 women, and 510 adults were randomized, including 264 men and 246 women. The goal was to recruit approximately equal numbers of men and women to examine results separately in men and women. A total of 470 of 510 participants (92.2%) completed at least 1 follow-up assessment. Data were collected from October 3, 2011, to January 14, 2016. Data were analyzed from February 1, 2016, to May 1, 2020. Interventions: ImPAT focused on how a psychosocial model of pain was associated with functioning and relapse prevention and provides skills to manage pain. SPC served as the active control condition and involved discussions of topics like nutrition and the course of addiction, which were intended to be relevant to the patient population and to have face validity but be distinct from the content of ImPAT. Main Outcomes and Measurements: The primary outcomes were pain intensity, pain-related functioning, and behavioral pain tolerance at 12 months. Secondary outcomes were frequency of alcohol and drug use over 12 months. Results: Of the 510 included participants, the mean (SD) age was 34.8 (10.3) years. A total of 133 men and 122 women were assigned to ImPAT, and a total of 131 men and 124 women were assigned to the SPC condition. Over 12 months of follow-up, randomization to the ImPAT intervention was associated with higher tolerance of pain among men, higher by a mean score of 0.11 (95% CI, 0.03 to 0.18; P = .004; Cohen d = 0.40) at 3 months and by 0.07 (95% CI, -0.01 to 0.19; P = .11; Cohen d = 0.25) at 12 months. Women receiving the ImPAT intervention experienced a reduction in pain intensity from 3 to 12 months, while women receiving the SPC condition experienced an increase in pain intensity, resulting in lower pain in the ImPAT condition by a mean score of 0.58 (95% CI, -0.07 to 1.22; P = .08; Cohen d = -0.22) at 12 months. No differences were found between the ImPAT and SPC conditions on alcohol or drug use. Conclusions and Relevance: Behavioral pain management is not typically included in addiction treatment, but the present results indicate that this type of intervention was associated with better pain-related outcomes, including pain tolerance in men and pain intensity in women. Improvements in substance use-related outcomes beyond that achieved by treatment as usual were not observed. Treatment programs should consider providing psychosocial pain management services to augment standard addiction treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT01372267.

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Crossref · 10.1001/jamapsychiatry.2020.2369

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  • In one trial, the effect of multi-component intervention on pain was significant only among women participants.

    “one trial found this effect was only significant among women participants. 40”

    From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [40]

    The Results section (“Pain Intensity, Pain-Related Functioning, and Pain Tolerance”) reports a significant improvement in pain intensity among women but not men. However, it also reports a significant improvement in pain tolerance among men, so the broader claim that the intervention’s effect on pain was significant only among women is not supported. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Of the remaining 4 SUD trials with a medium-term follow-up, a small-to-medium effect on pain reduction from baseline to medium-term follow-up was reported in all.

    “Of the remaining 4 trials with a medium-term followup, 30,39,40,45 although a small-to-medium effect on pain reduction from baseline to medium-term follow-up was reported in all, with 1 reporting a large ES, 30 one trial found this effect was only significant among women participants. 40”

    From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [40]

    The Pain Intensity, Pain-Related Functioning, and Pain Tolerance section (page unavailable) reports a small pain-intensity effect (Cohen d = -0.22) and a significant treatment-by-time interaction in women but not men. It reports that effect at 12 months, however, rather than a quantified reduction from baseline to medium-term follow-up. This paper also cannot establish the citing sentence’s claim about all four trials. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • Among the 10 SUD trials, two evaluated a CBT-based intervention, three included a MBI (one of which involved integrated MBI and ACT), two examined a MCI, one included a pharmacological-based treatment, and 2 involved a body-based intervention.

    “Two trials eval­ uated a CBT-based intervention, 20,23 three included a MBI, 27,28,30 one of which involved integrated MBI and ACT, 30 two examined a MCI, 39,40 one included a phar­ macological-based treatment, 45 and 2 involved a bodybased intervention. 35,36”
  • Another 4 large trials included an intervention with multiple components.

    “Another 4 large trials included an intervention with multiple components. 37-40”
  • One of those 4 SUD trials found the effect on pain reduction was only significant among women participants.

    “Of the remaining 4 trials with a medium-term followup, 30,39,40,45 although a small-to-medium effect on pain reduction from baseline to medium-term follow-up was reported in all, with 1 reporting a large ES, 30 one trial found this effect was only significant among women participants. 40”

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Authors
Ilgen, M. A., Coughlin, L. N., Bohnert, A. S. B., Chermack, S., Price, A., Kim, H. M., Jannausch, M., & Blow, F. C.
Affiliations
University of Michigan (US)
Corresponding author
Ilgen, Mark A.
Venue
JAMA Psychiatry
Published
2020-12-01
Volume
77
Issue
12
Pages
1225
ISSN
2168-622X (ISSN-L)
OpenAlex
W3046188346
Cited by
33
References
44
Citations by year
2026: 6 · 2025: 4 · 2024: 13 · 2023: 5 · 2022: 3 · 2021: 2
FWCI
1.79
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Northrop Grumman
  • National Institute on Alcohol Abuse and Alcoholism (K23AA028232, T32AA007477)
  • National Institute of Mental Health (R15MH113108)
  • National Institute on Drug Abuse
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Keywords
chronic pain, substance use disorders, addiction treatment, pain tolerance, pain intensity, relapse prevention, gender differences, alcohol consumption, drug use, residential treatment, substance use disorder treatment outcomes, coping skills training, mindfulness training
MeSH terms
Psychosocial Intervention, Adult, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Education as Topic, Sex Factors, Outcome Assessment, Health Care, Substance-Related Disorders, Young Adult, Chronic Pain, Pain Management

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