Utilizing Primary Care to Engage Patients on Opioids in a Psychological Intervention for Chronic Pain

Miller-Matero, Lisa R; Chohan, Sikander; Gavrilova, Lyubov; Hecht, Leah M; Autio, Kirsti; Tobin, Erin T.; Ahmedani, Brian K.

doi:10.1080/10826084.2022.2096239

Cited by 3 publications

(12 citation statements)

References 25 publications

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“…This may suggest that among those with an opioid prescription, those with daily use or higher dosages are not necessarily less interested in psychological treatments. This was supported by other work that suggested that the dose of opioids was not associated with enrollment in a study examining a psychological intervention for pain management 39 …”

Section: Discussionsupporting

confidence: 64%

“…This was supported by other work that suggested that the dose of opioids was not associated with enrollment in a study examining a psychological intervention for pain management. 39 There are several limitations to note. First, this study measured patient interest in receiving psychological treatment for pain with a single item and did not measure actual engagement in a psychological intervention.…”

Section: Discussionmentioning

confidence: 99%

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Factors Associated with Interest in Engaging in Psychological Interventions for Pain Management

Miller-Matero,

Yaldo,

Chohan

et al. 2023

The Clinical Journal of Pain

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Objective: Engagement in evidence-based psychological interventions for pain management is low. Identifying characteristics associated with interest in interventions can inform approaches to increase uptake and engagement. The purpose of this study was to examine factors associated with interest in psychological interventions among persons with non-cancer pain receiving prescription opioids. Methods:Participants with non-cancer pain and a new 30-90 day opioid prescription were recruited from two health systems. Participants (N=845) completed measures regarding pain, opioid use, psychiatric symptoms, emotional support, and interest in psychological interventions for pain management. Results: There were 245 (29.0%) participants who reported high interest in psychological interventions for pain management. In bivariate analyses, variables associated with interest included younger age, female gender, greater pain severity, greater pain interference, greater number of pain sites, lower emotional support, depression, anxiety, and post-traumatic stress disorder (P<0.05). In a multivariate model, greater pain severity (OR=1.17; CI: 1.04-1.32), depression (OR=2.10; CI: 1.39-3.16), PTSD (OR=1.85; CI: 1.19-2.95), and lower emotional support (OR=0.69; CI: 0.5-0.97) remained statistically significant. Discussion: The rate of interest in psychological interventions for pain management was low, which may indicate that patients initiating opioid treatment of chronic pain have low interest in psychological interventions. Greater pain severity and psychiatric distress were related to interest, and patients with these characteristics may especially benefit from psychological interventions. Providers may want to refer to psychological interventions prior to or when opioids are initiated. Additional work is needed to determine if this would reduce long-term opioid use.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Factors Associated with Interest in Engaging in Psychological Interventions for Pain Management

Miller-Matero,

Yaldo,

Chohan

et al. 2023

The Clinical Journal of Pain

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“…As shown in Figure 1 , the 39 studies used a broad range of research designs; nineteen randomized controlled trials (RCTs) [ 2 , 7 , 29 , 30 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ], eighteen non-randomized observational studies (e.g., prospective and retrospective cohort studies, case studies, quasi-experimental studies) [ 1 , 3 , 5 , 10 , 14 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ], and two secondary analyses of RCTs [ 66 , 67 ] met the inclusion criteria. The final 39 articles were tabled and analyzed according to the level of hierarchy ( Table 1 below and supplementary material Table S1 : Characteristics of Included Studies).…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-three [85%, 33/39] studies reported the mean age (54.5 years old) [ 1 , 2 , 3 , 7 , 14 , 29 , 38 , 40 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 64 , 65 , 66 , 67 ] and six [15%, 6/39] studies did not report mean age [ 5 , 10 , 30 , 39 , 53 , 63 ]. Thirty-nine [100%, 39/39] studies provided the biological sex of the study participants and the percentage of females ranged from 9.2% [ 50 ] to 100% [ 66 ]. Twenty-eight [72%, 28/39] studies reported race and ethnicity characteristics.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-eight [72%, 28/39] studies reported race and ethnicity characteristics. Only four studies [10%, 4/39] included a sample of >50% underrepresented populations [ 44 , 51 , 65 , 66 ]. Miller-Matero et al (2022) had the highest percentage of Black (88.3%) participants, and Sandhu et al (2023) had the highest percentage of White (96.2%) participants, respectively, as shown in supplementary material Table S1 : Characteristics of Included Studies.…”

Section: Resultsmentioning

confidence: 99%

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The Impact of Nonpharmacological Interventions on Opioid Use for Chronic Noncancer Pain: A Scoping Review

Coffee,

Cheng,

Slebodnik

et al. 2024

IJERPH

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Despite the lack of evidence, opioids are still routinely used as a solution to long-term management for chronic noncancer pain (CNCP). Given the significant risks associated with long-term opioid use, including the increased number of unregulated opioid pills at large in the opioid ecosystem, opioid cessation or reduction may be the desired goal of the patient and clinician. Viable nonpharmacological interventions (NPIs) to complement and/or replace opioids for CNCP are needed. Comprehensive reviews that address the impact of NPIs to help adults with CNCP reduce opioid use safely are lacking. We conducted a literature search in PubMed, CINAHL, Embase, PsycINFO, and Scopus for studies published in English. The initial search was conducted in April 2021, and updated in January 2024. The literature search yielded 19,190 relevant articles. Thirty-nine studies met the eligibility criteria and underwent data extraction. Of these, nineteen (49%) were randomized controlled trials, eighteen (46%) were observational studies, and two (5%) were secondary analyses. Among adults with CNCP who use opioids for pain management, studies on mindfulness, yoga, educational programs, certain devices or digital technology, chiropractic, and combination NPIs suggest that they might be an effective approach for reducing both pain intensity and opioid use, but other NPIs did not show a significant effect (e.g., hypnosis, virtual reality). This review revealed there is a small to moderate body of literature demonstrating that some NPIs might be an effective and safe approach for reducing pain and opioid use, concurrently.

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Depression and Pain

Miller-Matero

2024

Pain, the Opioid Epidemic, and Depression

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Individuals with chronic pain are at risk for experiencing psychiatric symptoms, including depression, and this relationship is likely bidirectional. As depressive symptoms worsen or improve, pain-related variables, including pain severity, pain interference, and pain catastrophizing respond similarly. As such, psychological interventions have been developed and tested that can target pain and depression simultaneously. Interventions that have garnered the most attention include cognitive-behavioral therapy (CBT), mindfulness, and acceptance and commitment therapy (ACT). In addition, those with co-occurring pain and depression are at greater risk for opioid misuse and opioid use disorder. More recent work has focused on using similar psychological strategies to improve opioid-related outcomes. There remain challenges in managing comorbid pain, depression, and opioid use, including interventions resulting in modest effect sizes, generalizability, and low uptake and engagement in psychological interventions. Potential solutions include tailoring treatments and offering interventions in medical settings or via telehealth.

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Utilizing Primary Care to Engage Patients on Opioids in a Psychological Intervention for Chronic Pain

Cited by 3 publications

References 25 publications

Factors Associated with Interest in Engaging in Psychological Interventions for Pain Management

Factors Associated with Interest in Engaging in Psychological Interventions for Pain Management

The Impact of Nonpharmacological Interventions on Opioid Use for Chronic Noncancer Pain: A Scoping Review

Depression and Pain

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