Two chronic medical conditions — chronic pain and opioid use disorder — have been pivotal to the unfolding of the current opioid epidemic in the United States. Individuals with these inter-related conditions report nonmedical opioid use to manage pain, and providers are frustrated with the absence of an integrated treatment approach.
A study by Yale researchers led by Declan Barry, PhD, Associate Professor of Psychiatry and Child Study developed an integrated treatment approach combining psychotherapy (cognitive-behavioral therapy [CBT]) with medication-assisted treatment (methadone maintenance). A pilot randomized clinical trial of 40 patients with opioid use disorder and chronic pain demonstrated the feasibility and acceptability of this approach. Furthermore, compared to patients receiving treatment-as-usual involving drug counseling and methadone maintenance, patients assigned to CBT and methadone maintenance were more likely to be abstinent from nonmedical opioid use over the course of the 12-week trial.
Reduced opioid use was not associated with an exacerbation of pain, a common patient concern. Instead, patients receiving CBT and treatment-as-usual exhibited similar improved pain outcomes. The researchers believe that further examination of integrated treatment models involving psychotherapy combined with medication-assisted treatment is warranted for patients with opioid use disorder and chronic pain.
The study was published in Drug and Alcohol Dependence. The senior author was Richard Schottenfeld, MD. Other Yale researchers included Mark Beitel, PhD; Christopher Cutter, PhD; David Fiellin, MD; Robert Kerns, PhD; Brent Moore, PhD; Lindsay Oberleitner, PhD; and Lynn Madden, PhD.