Substance misuse treatment for high-risk chronic pain patients on opioid therapy: A randomized trial

Jamison, Robert N.; Ross, Edgar L.; Michna, Edward; Chen, Li Q.; Holcomb, Caroline; Wasan, Ajay D.

doi:10.1016/j.pain.2010.02.033

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Volume 150, Issue 3 , Pages 390-400, September 2010

Substance misuse treatment for high-risk chronic pain patients on opioid therapy: A randomized trial

Robert N. Jamison
- Pain Management Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Corresponding author. Address: Departments of Anesthesia and Psychiatry, Brigham and Women’s Hospital, Pain Management Center, 850 Boylston Street, Suite 320, Chestnut Hill, MA 02467, USA. Tel.: +1 617 732 9046; fax: +1 617 732 9050.
Edgar L. Ross
- Pain Management Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
Edward Michna
- Pain Management Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
Li Q. Chen
- Pain Management Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
Caroline Holcomb
- Pain Management Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
Ajay D. Wasan
- Pain Management Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Received 22 July 2009; received in revised form 11 January 2010; accepted 18 February 2010. published online 24 March 2010.

Abstract

Chronic pain patients who show aberrant drug-related behavior often are discontinued from treatment when they are noncompliant with their use of opioids for pain. The purpose of this study was to conduct a randomized trial in patients who were prescribed opioids for noncancer back pain and who showed risk potential for or demonstration of opioid misuse to see if close monitoring and cognitive behavioral substance misuse counseling could increase overall compliance with opioids. Forty-two patients meeting criteria for high-risk for opioid misuse were randomized to either standard control (High-Risk Control; N=21) or experimental compliance treatment consisting of monthly urine screens, compliance checklists, and individual and group motivational counseling (High-Risk Experimental; N=21). Twenty patients who met criteria indicating low potential for misuse were recruited to a low-risk control group (Low-Risk Control). Patients were followed for 6months and completed pre- and post-study questionnaires and monthly electronic diaries. Outcomes consisted of the percent with a positive Drug Misuse Index (DMI), which was a composite score of self-reported drug misuse (Prescription Drug Use Questionnaire), physician-reported abuse behavior (Addiction Behavior Checklist), and abnormal urine toxicology results. Significant differences were found between groups with 73.7% of the High-Risk Control patients demonstrating positive scores on the DMI compared with 26.3% from the High-Risk Experimental group and 25.0% from the Low-Risk Controls (p<0.05). The results of this study demonstrate support for the benefits of a brief behavioral intervention in the management of opioid compliance among chronic back pain patient at high-risk for prescription opioid misuse.