Bench to bedside: comorbid pain and opioid addiction psycho-physiological data to develop novel psychotherapy interventions

Abstract

Aims: This study series developed a novel psychotherapy treatment for comorbid pain and opioid addiction (COAP) based on psycho-physiological data. Study 1 evaluated psychophysiological changes pain sensitivity and tolerance with opioid treatments; and duration of this effect after treatment cessation. Study 2 developed a 12-week rolling entry CBT with Self-regulation psychotherapy treatment based on the psychophysiological data. Study 3 piloted this novel treatment, entitled Self-regulation Therapy for Opioid addiction and Pain(STOP). Method: 120 chronic pain individuals were recruited in 4 groups(n=30): 1-current methadone for opioid addiction; 2-current buprenorphine for opioid addiction; 3-history of opioid treatment for opioid addiction but with current opioid abstinence (M=121 weeks;SD=23.3);and 4-opioid-naïve and completed psychopsychological assessment during a pain task, recording time to first pain (sensitivity) and time to disengagement from the pain task (tolerance). Analyses used survival analysis. In the pilot study, 20 participants completed pre-post intervention and psychophysiological testing, with weekly craving and urine toxicology. Results: Kaplan-Meier-Cox analyses showed group differences for pain sensitivity and tolerance (Log rank=20.11;p<.001). Opioid treatment groups showed sensitivity differences compared to opioid-naïve(p’s<.01). Tolerance improved across methadone-use to prolonged abstinence to opioid-naïve participants (p’s<.001). Within prolonged abstinent, pain tolerance increased as duration since last opioid increased (R=.37;p<.05); but abstinence duration did not alter sensitivity(ns). Intervention pre-post data showed improvements in pain tolerance, daily activity, decreased cravings, and no illicit substance use after week 8. Conclusion: Long-term differences in pain sensitivity do not resolve with discontinuation of opioid treatment. Although sensitivity does not change, pain tolerance increases after opioid cessation which has implications for treating COAP. The STOP pilot shows potential for improving treatment of COAP.