Presented at the 2012 AAPM Annual Meeting « Back

Chronic Pain and Substance Use: Treatment Outcomes for High-Risk Chronic Pain Patients Following Intensive Interdisciplinary Pain Rehabilitation

Sarah E. Hayes, Student, sarahhayes@nyu.edu¹, Elizabeth J. Luger, BS¹, Miranda N. Bretz, BA¹, Cynthia O. Townsend, PhD LP ABPP¹, W. Michael Hooten, MD¹, (1) Mayo Clinic, Rochester, Minnesota

Introduction: Effective clinical practice for addressing substance use in chronic pain patients has not been established. The study aims to determine the efficacy of 3-week interdisciplinary pain rehabilitation treatment for patients with chronic pain who have increased risk for substance abuse. Methods and Materials: This study was approved by the IRB, and involved 476 patients with debilitating chronic pain consecutively admitted to the Mayo Pain Rehabilitation Center from February 2010 to May 2011. Upon admission, high-risk patients with history of chemical dependency, high-dose opioids and/or mood altering substances participated in daily substance use group sessions in addition to cognitive behavioral therapies. Patient functioning at admission and discharge was assessed using the Multidimensional Pain Inventory, Center for Epidemiological Studies-Depression, Pain Self-Efficacy Questionnaire and Pain Catastrophizing Scale. Results: High-risk patients (n = 246) did not differ from low-risk patients (n = 230) on demographics, pain duration, or years of opioid use. High-risk patients used opioids, benzodiazepines, marijuana, tobacco, and alcohol at higher frequencies (p≤0.001). High-risk patients reported greater depression, pain catastrophizing, pain interference, and poorer pain self-efficacy (p≤0.001). Repeated measures analysis of variance revealed improvement on all treatment outcome measures (p≤0.001). No differences between high- and low- risk patients remained at discharge, indicating significant functional improvement for all patients. Conclusions: Substance use education incorporated into cognitive behavioral rehabilitation programming is effective to improve pain and functioning for chronic pain patients at high-risk for comorbid substance abuse.

Funding: None