The Effects of Psychological Treatments for Chronic Pain on Reducing Opioid Use in People at Risk for Opioid Misuse: A Randomized Feasibility Trial.

BACKGROUND AND

OBJECTIVE

Chronic pain is common and difficult to treat, with opioid analgesics continuing to be the most common treatment. However, opioids have only modest benefits. Research suggests that cognitive- and behaviorally-focused treatments may improve pain and reduce opioid use. The aim of this randomized feasibility trial was to determine if a fully powered clinical trial to evaluate the effects of three psychological chronic pain treatments-behavioral activation (BA), cognitive therapy (CT), and mindfulness meditation (MM)-on opioid use in individuals with chronic pain is warranted.

METHODS

The primary feasibility outcomes were enrollment to randomization rates, treatment expectancy, treatment engagement, study retention, treatment satisfaction, and the proportion of individuals decreasing their mean daily morphine milligram equivalents (MMEs).

RESULTS

Of 115 participants enrolled, 91 were randomized (79%). Average expectancy scores in all conditions were above the mean. While ≥ 75% of participants in CT and MM attended ≥ 4 treatment sessions, 74% did in BA which was just below the ≥ 75% feasibility threshold. At posttreatment, ≥ 90% of participants provided outcome data and most participants (76%, 79%, and 93% in MM, CT, and BA) reported they were either "satisfied" or "very satisfied" with treatment. At posttreatment, 21% in the BA group, 32% in CT, and 54% in MM reported decreased MMEs.

CONCLUSION

CT and MM met all feasibility criteria for inclusion in an appropriately powered comparative trial, however, BA failed to meet the threshold for one criterion, indicating necessary adjustments. The findings inform design specifications for a future definitive trial.

TRIAL REGISTRATION: The trial was preregistered on clinicaltrials.gov (Identifier: NCT03916276) prior to commencing participant enrollment.