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Chronic pain

Patients who have chronic pain and who also (ab)use drugs and alcohol pose a challenge, especially as many become dependent on drugs due to over-prescription.

An earlier study showed a psychosocial intervention, ImPAT (Improving Pain during Addiction Treatment) helped US Veterans. A large trial in 510 civilians, both men and women, has confirmed that this programme is effective at reducing pain; it does not affect drug or alcohol use.

The treatment programme has been described in detail (in 2011). It involves 12 session of Cognitive Behavioural Therapy combined with Acceptance Based Therapy and focuses on control of pain.

The study and paper are interesting for several reasons. It has taken at least ten years to move from initial development and piloting of the treatment to the production of strong evidence supporting effectiveness, demonstrating the vital need to commit resources to the development and then evaluation of therapies. Research funding needs to facilitate the establishment and maintenance of research groups able to see the process through.

The intervention has been effective in a group of patients that are most difficult to help. It should be equally or more effective in people who do not also have problems with drug dependence and abuse.

Last it is an illustration of what might be meant by, or included within, the umbrella term of ‘psychosocial’.

Ilgen MA, Coughlin LN, Bohnert ASB, et al.
Efficacy of a Psychosocial Pain Management Intervention for Men and Women With Substance Use Disorders and Chronic Pain: A Randomized Clinical Trial. 
JAMA Psychiatry.2020;77(12):1225–1234. doi:10.1001/jamapsychiatry.2020.2369

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