Effectiveness of Self-Management for the Treatment of Chronic Pain and Aberrant Medication-Taking Behavior: Patients’ Experiences witha Web-based, Cognitive Behavior Therapy Intervention
Honoria Guarino, Sarah K. Moore, Lisa A. Marsch, Andrew Rosenblum
Given heightened concern about the limitations and risks of long-term opioid therapy, non-pharmacological modalities for treating chronic pain are increasingly recommended and may be especially valuable for pain patients with histories of medication misuse. Self-management approaches such as Cognitive Behavior Therapy(CBT) have been found effective for chronic pain, yet remain under-utilized. This study explores the experiences and perspectives of chronic pain patients with aberrant medication-taking behavior (AMTB) who participated in a clinical trial to evaluate a novel web-based self-management intervention.Chronic pain patients meeting criteria for AMTB were randomized to 12 weeks of treatment-as-usual (TAU; n=55) or TAU plus the web-based intervention(n=55). Semi-structured, qualitative interviews were conducted post-intervention with 24 patientsrandomized to the web-based group to explore their perspectives on the intervention and how use of the program’s CBT skills affected their experience of chronic pain. Audio-recorded interviews were transcribed andanalyzed for dominant themes.Trial results demonstrated that patients in the web-based group reported significantly less AMTB and pain catastrophizing than those in the TAU group, although no significant differences in pain severity or pain interference were observed. In qualitative interviews, patients offered valuable insights into perceived effects of the web-based program that allow for a more nuanced interpretation of trial outcomes. Interviewees emphasized that the web-based program: fostered a new sense of agency over the pain experience; provided tools to better cope with pain that helped reduce pain-related distress irrespective of changes in pain severity; helped increase activity through goal setting content and interactive features; and appealed as an alternative to medication, enabling some to reduce opioid intake. Findings highlight the perceived utility of a self-management approach for improving patients’ ability to cope with pain. Technology-based approaches may help foster wider adoption of evidence-based behavioral therapies such as CBT in chronic pain treatment.
Supported by NIH/NIDA Grant #R01DA026887 to Andrew Rosenblum and Lisa A. Marsch. Honoria Guarino received a pilot grant from the Center for Technology and Behavioral Health at Dartmouth College, a NIDA-funded P30 Center, to conduct a qualitative process research component of this parent study.