An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain
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Aims The primary study aim was to evaluate the feasibility and acceptability of cognitive-behavioral therapy (CBT) for opioid use disorder and chronic pain. The secondary aim was to examine its preliminary efficacy. Methods In a 12-week pilot randomized clinical trial, 40 methadone-maintained patients were assigned to receive weekly manualized CBT (n = 21) or Methadone Drug Counseling (MDC) to approximate usual drug counseling (n = 19). Results Twenty of 21 patients assigned to CBT and 18 of 19 assigned to MDC completed the pilot study. Mean (SD) sessions attended were 8.4 (2.9) for CBT (out of 12 possible) and 3.8 (1.1) for MDC (out of 4 possible); mean (SD) patient satisfaction ratings (scored on 1-7 Likert-type scales) were 6.6 (0.5) for CBT and 6.0 (0.4) for MDC (p < .001). The proportion of patients abstinent during the baseline and each successive 4-week interval was higher for patients assigned to CBT than for those assigned to MDC [Wald χ 2 (1) = 5.47, p = .02]; time effects (p = .69) and interaction effects between treatment condition and time (p = .10) were not significant. Rates of clinically significant change from baseline to end of treatment on pain interference (42.9% vs. 42.1%, [χ 2 (1, N = 40) = 0.002, p = 0.96]) did not differ significantly for patients assigned to CBT or MDC. Conclusions We found support for the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy relative to standard drug counseling in promoting abstinence from nonmedical opioid use among patients with opioid use disorder and chronic pain. Overall, patients exhibited improved pain outcomes, but these improvements did not differ significantly by treatment condition.
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Of the 4 SUD trials with a short-term follow-up, two out of 4 studies reported statistically significant improvements in pain intensity in the intervention group.
“Of the 4 trials with a shortterm follow-up, 20,27,28,36 two out of 4 studies reported statistically significant improvements in pain intensity in the intervention group, 27,36”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [20]
The Results section (Pain interference and intensity; page unavailable) reports that pain-intensity improvement did not differ significantly between the intervention and comparison groups (p=0.894), and that weekly pain-intensity analyses found no significant treatment-group or group-by-time effects. Although 14.3% of intervention patients had a clinically significant reduction, the paper does not report that this was a statistically significant improvement in the intervention group. (LLM, conf=0.84)
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Experimental — accuracy not yet measuredReduced opioid craving post-treatment was found in 3 of those 4 SUD trials.
“All 4 trials included drug screens, and reduced opioid craving post-treatment was also found in 3. 20,27,28”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [20]
The Methods > Measures section says this trial used weekly urine toxicology testing, supporting the drug-screen portion of the citing sentence. It does not report a post-treatment reduction in opioid craving; the Results > Nonmedical opioid use section reports abstinence instead. The cited paper therefore does not support counting this trial among the three with reduced craving. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSynthesising evidence from 4 trials of a CBT-based intervention, this type of intervention has a positive effect on pain-related and mental health outcomes, particularly pain severity, pain-related efficacy, depression severity, and opioid use, at least for people with either depression or OUD until end-of-treatment.
“Synthesising evidence from 4 trials included a CBTbased intervention, 20-23 it appears that this type of in tervention has a positive effect on pain-related (parti cularly pain severity and pain-related efficacy) and MH outcomes (particularly depression severity and opioid use), at least for people with either depression or OUD till end-of-treatment period.”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [20]
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Experimental — accuracy not yet measuredAmong 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”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [20]
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References 58 · Cited by 81
Research works printed but not linked: 2
- Cleeland CS, 1991 Pain assessment in cancer. In: Osaba D (Ed.), Effect of cancer on quality of life CRC Press, Boca Raton, FL pp. 293– 305.
- Institute of Medicine, 2011 Relieving pain in America: A blueprint for transforming prevention, care, education and research The National Academies Press, Washington, DC. 22553896
- Authors
- Barry, D. T., Beitel, M., Cutter, C. J., Fiellin, D. A., Kerns, R. D., Moore, B. A., Oberleitner, L., Madden, L. M., Liong, C., Ginn, J., & Schottenfeld, R. S.
- Affiliations
- Yale University (US)
- APT Foundation (US)
- Corresponding author
- Barry, Declan T.
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2019-01
- Volume
- 194
- Pages
- 460-467
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC6312460
- OpenAlex
- W2900624226
- Cited by
- 81
- References
- 58
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 12 · 2023: 9 · 2022: 10 · 2021: 14 · 2020: 16 · 2019: 6 · 2014: 1
- FWCI
- 8.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (K23 DA024050, K24 DA000445, R01DA024695, K01 DA022398)
- Veterans Health Administration Health Services Research and Development Service Center of Innovation (CIN 13-407)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- cognitive behavioral therapy, opioid use disorder, chronic pain, methadone maintenance treatment, drug counseling, treatment feasibility, acceptability, opioid abstinence, pain interference, nonmedical opioid use
- MeSH terms
- Adult, Analgesics, Opioid, Combined Modality Therapy, Feasibility Studies, Female, Humans, Male, Methadone, Middle Aged, Opioid-Related Disorders, Pilot Projects, Cognitive Behavioral Therapy, Treatment Outcome, Patient Satisfaction, Opiate Substitution Treatment, Chronic Pain
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