Treating Chronic Pain in Buprenorphine Patients in Primary Care Settings

Inclusion Criteria:

- Chronic Pain, defined as pain duration for at least six months with a mean score of 5
or higher on the BPI Pain Interference Scale;

- Pain severity of 40 or higher on a Visual Analog Scale (0-100) indicating "worst pain
in the last week";

- Previous attempt at initial steps of PCP guideline pain care: must have had at least
one trial of recommended medication (i.e. acetaminophen, NSAIDS, skeletal muscle
relaxants) judged through interviews with patients and PCPs;

- QIDS score of ≥ 10 (depression severity)

- If using an antidepressant, the dose must be stable for the previous 2 months;

- Age 18 or older

- Has received buprenorphine/naloxone (Suboxone)for at least the last 3 months;

- Plan to continue buprenorphine/naloxone (Suboxone)for at least 3 months.

Exclusion Criteria:

- Lifetime DSM-IV diagnosis of bipolar disorder, schizophrenia, or other chronic
psychotic condition;

- Current DSM-IV diagnosis of substance dependence for sedative/hypnotic drugs,
alcohol, stimulants, or cocaine;

- Suicidal ideation or behavior requiring immediate attention;

- In psychotherapy or in a multidisciplinary pain management program at baseline;

- Anticipate having surgery in the next 6 months;

- Pain thought to be due to cancer, infection, inflammatory arthritis, or associated
with severe or progressive neurological deficits;

- SSDI or SSI claim pending;

- Pregnancy.