Chronic pain, or pain lasting at least three months, is common among patients in opioid agonist treatment (OAT), and is associated with high rates of unremitting anxiety and mood disorders, non-opioid substance-related disorders, personality disorders, and licit along with illicit substance use to manage pain.
Addiction counselors report both difficulty managing the clinical needs of patients with chronic pain and interest in receiving training on chronic pain management. However, no published pain curricula exist for this provider group. Extant curricula for medical providers emphasize topics which diverge from counselors’ training and scope of practice needs.
To address this training gap, an interdisciplinary team led by Declan Barry, PhD, Associate Professor of Psychiatry, developed, implemented, and conducted an initial evaluation of a bespoke onsite training for counselors on a brief psychosocial intervention for OAT patients with chronic pain.
The team recently published a paper in Substance Abuse demonstrating the promise of this approach.
The investigators who developed the training were all affiliated with the APT Foundation, Inc. and Yale School of Medicine, and included faculty and fellows from Internal Medicine (Jenna Butner, MD, Clinical Instructor, first author; Curtis Bone, MD, Research in Addiction Medicine Fellow) and Psychiatry (Caridad Ponce Martinez, MD, Addiction Psychiatry Fellow; Grace Kwon, MD, Addiction Psychiatry Fellow; Mark Beitel, PhD, Assistant Clinical Professor; Lynn Madden, PhD, MPA, Instructor; and Barry).
The training, which was completed by 52 APT counselors, targeted pain screening, psychoeducation, and goal setting involving exercise. Data on counselors’ knowledge, attitudes, interest, and perceived ability was collected before (pre-test) and after (post-test) the training, and six months later (follow-up). Compared to pre-test, mean counselor knowledge scores increased significantly post-training and at follow-up, and the training was associated with increases in positive attitudes toward counselors’ role in managing chronic pain, interest in assessing chronic pain, and counselor ability to assess as well as suggest appropriate interventions for managing pain.
The authors conclude that further research should both evaluate the counselor training at other OAT sites and examine whether additional components of an interdisciplinary approach to chronic pain management can be introduced into OAT settings in a cost-effective manner.