Web-based Cognitive-behavior Therapy (CBT) for Opioid-treated, Chronic Pain Patients With Aberrant Behavior

Although opioid therapy has gained increasing acceptance as a treatment for patients with
chronic, non-malignant pain, concerns persist related to achievement of treatment goals and
medication misuse/abuse within the clinical context(often described as aberrant drug-related
behavior). Psychosocial approaches, particularly self-manangement strategies such as
cognitive-behavior therapy (CBT), have been found to be efficacious for the treatment of
chronic pain. However, most chronic pain patients are not exposed to comprehensive
psychosocial interventions, largely due to the lack of expertise and time among physicians
who prescribe opioids. To address this public health concern, this study will develop,
implement and evaluate an innovative CBT intervention for the treatment of chronic pain
tailored to the specific needs of patients who are prescribed opioids and present with
aberrant behaviors. The development of this interactive, web-based intervention will include
input as well as feedback on a beta version from pain experts and chronic pain patients.
Once the intervention has been developed, we will conduct a controlled efficacy trial in
which chronic pain patients maintained on opioids will be randomized to receive either
treatment-as-usual (n=55) or treatment-as-usual plus the computer-delivered intervention
(n=55). In addition to conducting statistical analyses to evaluate the relative efficacy of
these two interventions, we will examine two hypothesized mediators of treatment outcome -
i.e., cognitive distortions relative to pain management and coping, and expectations about
the future.

Inclusion Criteria:

- moderate-to-severe pain for at least 3 months (score of 5 or greater on Brief Pain
Inventory)

- new patients at pain treatment program study site (within 60 days of treatment entry)
prescribed opioid analgesics

- aberrant drug-related behavior within the past 6 months (endorsing 4 or more items on
the Current Opioid Misuse Measure)

Exclusion Criteria:

- primary headache or cancer pain

- scheduled for major surgery within the next 6 months

- described by physician as likely to die within the next year

- plans to move out of the area within the next 3 months

- insufficient ability to provide informed consent or insufficient English to
participate in consent process, assessments or computer intervention