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首页> 外文期刊>JAMA psychiatry >Efficacy of a Psychosocial Pain Management Intervention for Men and Women With Substance Use Disorders and Chronic Pain A Randomized Clinical Trial
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Efficacy of a Psychosocial Pain Management Intervention for Men and Women With Substance Use Disorders and Chronic Pain A Randomized Clinical Trial

机译：用于物质使用障碍和慢性疼痛的男性和女性的心理社会疼痛管理干预的疗效A随机临床试验

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Importance Chronic pain is common in those with substance use disorders (SUDs) and predicts poorer addiction treatment outcomes. A critical challenge for addiction treatment is to develop effective methods to improve pain-related and substance use-related outcomes for those in treatment for SUDs. Objective To examine the efficacy of an integrated behavioral pain management intervention (Improving Pain During Addiction Treatment [ImPAT]) for men and women with SUDs to treat pain, functioning, and substance use. Design, Setting, and Participants In this randomized clinical trial, 8 sessions of ImPAT were compared with 8 sessions of a supportive psychoeducational control (SPC) condition for adults with pain treated at a large residential SUD treatment program. Follow-up occurred at 3, 6, and 12 months postbaseline. A total of 1372 adults were screened, including 960 men and 412 women, and 510 adults were randomized, including 264 men and 246 women. The goal was to recruit approximately equal numbers of men and women to examine results separately in men and women. A total of 470 of 510 participants (92.2%) completed at least 1 follow-up assessment. Data were collected from October 3, 2011, to January 14, 2016. Data were analyzed from February 1, 2016, to May 1, 2020. Interventions ImPAT focused on how a psychosocial model of pain was associated with functioning and relapse prevention and provides skills to manage pain. SPC served as the active control condition and involved discussions of topics like nutrition and the course of addiction, which were intended to be relevant to the patient population and to have face validity but be distinct from the content of ImPAT. Main Outcomes and Measurements The primary outcomes were pain intensity, pain-related functioning, and behavioral pain tolerance at 12 months. Secondary outcomes were frequency of alcohol and drug use over 12 months. Results Of the 510 included participants, the mean (SD) age was 34.8 (10.3) years. A total of 133 men and 122 women were assigned to ImPAT, and a total of 131 men and 124 women were assigned to the SPC condition. Over 12 months of follow-up, randomization to the ImPAT intervention was associated with higher tolerance of pain among men, higher by a mean score of 0.11 (95% CI, 0.03 to 0.18; P = .004; Cohen d = 0.40) at 3 months and by 0.07 (95% CI, -0.01 to 0.19; P = .11; Cohen d = 0.25) at 12 months. Women receiving the ImPAT intervention experienced a reduction in pain intensity from 3 to 12 months, while women receiving the SPC condition experienced an increase in pain intensity, resulting in lower pain in the ImPAT condition by a mean score of 0.58 (95% CI, -0.07 to 1.22; P = .08; Cohen d = -0.22) at 12 months. No differences were found between the ImPAT and SPC conditions on alcohol or drug use. Conclusions and Relevance Behavioral pain management is not typically included in addiction treatment, but the present results indicate that this type of intervention was associated with better pain-related outcomes, including pain tolerance in men and pain intensity in women. Improvements in substance use-related outcomes beyond that achieved by treatment as usual were not observed. Treatment programs should consider providing psychosocial pain management services to augment standard addiction treatment.
机译：重要性慢性疼痛在药物使用障碍（SUD）患者中很常见，并预示着成瘾治疗效果较差。成瘾治疗的一个关键挑战是开发有效的方法，以改善那些正在接受肥皂水治疗的患者的疼痛相关和药物使用相关的结果。目的研究综合行为疼痛管理干预（改善成瘾治疗期间的疼痛[ImPAT]）对患有肥皂水的男性和女性治疗疼痛、功能和药物使用的效果。设计、设置和参与者在这项随机临床试验中，8次ImPAT治疗与8次支持性心理教育控制（SPC）治疗的成人疼痛进行了比较，后者在一个大型住宅SUD治疗项目中接受治疗。随访发生在基线检查后3个月、6个月和12个月。共筛查了1372名成年人，包括960名男性和412名女性，510名成年人被随机分组，包括264名男性和246名女性。目标是招募人数大致相等的男性和女性，分别对男性和女性的结果进行检查。510名参与者中共有470人（92.2%）完成了至少一次随访评估。数据收集时间为2011年10月3日至2016年1月14日。数据分析时间为2016年2月1日至2020年5月1日。干预措施ImPAT侧重于疼痛的心理社会模型如何与功能和复发预防相关联，并提供疼痛管理技能。SPC作为主动控制条件，涉及营养和成瘾过程等主题的讨论，旨在与患者群体相关，并具有面部效度，但不同于ImPAT的内容。主要结果和测量主要结果为12个月时的疼痛强度、疼痛相关功能和行为疼痛耐受性。次要结果是12个月内饮酒和吸毒的频率。结果510名参与者的平均年龄为34.8岁（10.3岁）。共有133名男性和122名女性被分配到ImPAT，共有131名男性和124名女性被分配到SPC状态。在12个月的随访中，ImPAT干预的随机化与男性更高的疼痛耐受性相关，在3个月时的平均得分为0.11（95%CI，0.03至0.18；P=0.004；Cohen d=0.40），在12个月时的平均得分为0.07（95%CI，-0.01至0.19；P=0.11；Cohen d=0.25）。接受ImPAT干预的女性疼痛强度从3个月降至12个月，而接受SPC治疗的女性疼痛强度增加，导致12个月时ImPAT治疗的疼痛平均分降低0.58（95%可信区间-0.07至1.22；P=0.08；科恩d=-0.22）。ImPAT和SPC在酒精或药物使用方面没有发现差异。结论和相关性行为性疼痛管理通常不包括在成瘾治疗中，但目前的结果表明，这种类型的干预与更好的疼痛相关结果相关，包括男性的疼痛耐受性和女性的疼痛强度。除常规治疗外，未观察到药物使用相关结果的改善。治疗方案应考虑提供心理社会疼痛管理服务，以加强标准成瘾治疗。

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