Internet-based Pain Self-Management for Persistent Pain Populations on Methadone Maintenance
WSU Alcohol and Drug Abuse Research Program – $30,000
7/1/15 – 7/1/16
This randomized controlled trial test the effects of an online pain self-management on a population of patients enrolled in an outpatient methadone treatment center with co-existing chronic pain.
Dr. Wilson and her research team seek to expand on novel treatment adjuncts at the Program of Excellence in Addictions Research (PEAR) at WSU focused on comorbid persistent (or chronic) pain and methadone maintenance for opioid addiction. Unresolved persistent pain and increased opioid prescriptions have been linked to significant healthcare costs, along with societal concerns of substance abuse and unintended overdose. The annual cost of persistent pain in the U.S. is estimated at $600 billion.1 Equally concerning is the rising number of individuals with opioid analgesic dependence or abuse that increased from 1.4 million to 1.8 million from 2004 to 2011.2 Opioid drug overdose death rates have more than tripled in the past two decades and currently are the second leading cause of accidental death in the US, surpassed only by motor vehicle accidents.3
The rise in opioid dependence is evidenced by the number of people participating in a methadone maintenance treatment program, the primary evidence-based treatment approach for those with an opioid addiction.4 From 2000 to 2010 the number of patients admitted for treatment for opioid analgesic dependence increased from 5,032 to 33,701.5 The majority (31.3%) of opioid-related overdose deaths are associated with methadone ingestion.6 Many who suffer from opioid addiction also suffer from comorbid chronic pain.7 Numerous research gaps have been identified and best practices are lacking for this complex patient population.8 A potential for dangerous synergistic consequences exists when methadone is prescribed in conjunction with other pain relieving medicines.8 Novel, cost-effective solutions are desperately needed to assure that people with substance use disorders and co-existing persistent pain conditions have access to pain management strategies that can increase their chances for successful recovery and reduce risks of overdose deaths.
The use of opioid medications for persistent pain remains controversial.9,10,11 Reducing the demand for opioid prescriptions may be achieved by increasing emphasis on psychosocial interventions and non-pharmacological, nonopioid treatments.12 Self-management programs have been well-established as a helpful means to increase self-efficacy among those with chronic conditions,13 which in turn can reduce symptoms, assist in coping with psychosocial issues, and affect long-term health outcomes.14,15,16 Strong evidence links increased pain self-efficacy to reductions in disability, pain intensity and affective symptoms.17 Whether pain self-management programs can reduce opiate use among patients remains unexplored. In part, this is due to difficulty in accurately estimating opioid intake. We propose a study that will address this barrier by recruiting persons enrolled in an outpatient methadone maintenance program, which precisely measures and dispenses opiate medicines. Given our previous research findings that self-reported opioid misuse behaviors and pain self-efficacy are positively affected from self-management exposure,18 we believe methadone maintenance treatment centers offer an ideal environment to improve on measurements and establish greater confidence for promoting pain self-management as a treatment adjunct.
We will investigate a self-management program designed to increase pain self-efficacy and promote non-pharmacologic pain strategies in a pilot population of participants enrolled in a medically-supervised methadone maintenance program and who have co-existing medically-confirmed chronic non-cancer pain. The early stage PI has surrounded herself with a research team that has extensive experience conducting behavioral pharmacology experiments, randomized controlled trials for substance use disorders, and Internet-based treatment investigations in various populations. The goal of this study is to perform a randomized controlled trial to evaluate the ability of an 8-week Internet-based pain self-management program to increase pain self-efficacy and reduce opioid misuse among participants. Participants will be randomized into 1 of 2 trial arms that will receive: 1) 8-week Internet-based pain self-management, or 2) wait-list attention control.