Presented at the 2013 AAPM Annual Meeting « Back

Predictors for Success in the Treatment of Aberrant Medication Abuse Behaviors with Cognitive Behavioral Therapy

David D. DiBenedetto, MD, ddibenedetto@bostonpaincare.com¹, Rachel Porter, MSN RN-BC¹, Lara Harris-David, MA LICSW², Mary Jane G. Estrada-Lyder, ANP-BC¹, Lee Silk, MD¹, Jennifer Brogan¹, Zahid Bajwa, MD¹, (1) Boston PainCare Center, Waltham, Massachusetts, (2) NASW, Waltham, Massachusetts

Purpose: Medication misuse is common among chronic pain patients treated with opioids. It may be reflective of a substance abuse (SA) disorder, but literature suggests that these behaviors might reflect poor coping. This study attempts to identify factors associated with successful treatment outcomes in patients exhibiting aberrant drug behaviors (ADB) that were provided cognitive behavioral therapy (CBT) in an intensive 8 week MedSafe program. Methods: With IRB approval, MedSafe patients at Boston PainCare were monitored with medical visits and provided CBT as a means of treating ADB. Predictive factors examined included results from urine drug tests; standardized tools assessing medication misuse (COMM), functional impairment (ODI), and quality of life (SF36); opioid dosages and administration. Results: Of the 22 patients over 6 months, 55% successfully completed the MedSafe program requirements. Of those, 83% were currently married, never divorced. Prior treatment for SA was received by 25%, compared to 50% of patients with unsuccessful treatment outcomes. Of the treatment failures, 30% were married and 50% divorced. Conclusions: Of the variables examined, only marital status and history of prior SA treatment were predictive of success. Inverse correlation between the COMM score and successful treatment may be due alteration of responses for secondary gain. Additional research on a larger sample group is needed to better identify characteristics that could predict treatment success in patients receiving CBT for ADB. Furthermore, longer-term follow up is needed to determine the impact of intensive behavioral intervention for the long-term treatment of ADB. References: 1) Fishbain, D.A.; Cole, B.; Lewis, J.; Rosomoff, H.L.; Rosomoff, R.S. What percentage of chronic nonmalignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence 2) Moore TM, Jones T, Browder JH, et al. A comparison of common screening methods for predicting aberrant drug-related behavior among patients receiving opioids for chronic pain management. Pain Med. 2009;10: 1426-1433. 3) Salimah H. Meghani, PhD, MBE, CRNP, Nancy L. Wiedemer, RN, MSN, CRNP, William C. Becker, MD, Ed J. Gracely, PhD, and Rollin M. Gallagher, MD, MPH. Predictors of Resolution of Aberrant Drug Behavior in Chronic Pain Patients Treated in a Structured Opioid Risk Management Program. Pain Med. July/August 2009; Volume 10(5); 858-865

Funding: None