An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain
An evaluation of the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy for opioid use disorder and chronic pain
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DOI：
10.1016/j.drugalcdep.2018.10.015
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发表时间：
2019-01-01
影响因子：
4.2
通讯作者：
Schottenfeld, Richard S.
中科院分区：
文献类型：
--
作者：
Barry, Declan T.;Beitel, Mark;Schottenfeld, Richard S.
目的：主要研究目的是评估认知行为疗法（CBT）治疗阿片类药物使用障碍和慢性疼痛的可行性和可接受性。第二个目的是检查其初步疗效。方法：在一项为期 12 周的试点随机临床试验中，40 名美沙酮维持治疗患者被分配接受每周手动 CBT (n = 21) 或美沙酮药物咨询 (MDC)，以接近常规药物咨询 (n = 19)。结果：分配到 CBT 的 20 名患者和分配到 MDC 的 19 名患者中的 18 名完成了试点研究。 CBT 的平均 (SD) 会议次数为 8.4 (2.9)（满分 12 次），MDC 的平均 (SD) 为 3.8 (1.1) 次（满分 4 次）； CBT 的平均 (SD) 患者满意度评分（按 1-7 Likert 型量表评分）为 6.6 (0.5)，MDC 为 6.0 (0.4) (p < .001)。分配到 CBT 的患者在基线期间和每个连续 4 周间隔期间戒烟的患者比例高于分配到 MDC 的患者 [Wald chi(2) (1) = 5.47, p = .02]；时间效应 (p = .69) 以及治疗条件和时间之间的交互效应 (p = .10) 并不显着。对于分配到 CBT 或 MDC 的患者，从基线到治疗结束时疼痛干扰的临床显着变化率（42.9% vs. 42.1%，[chi(2) (1, N = 40) = 0.002，p = 0.96]）没有显着差异。结论：我们发现认知行为治疗相对于标准药物咨询在促进非药物戒断方面的可行性、可接受性和初步疗效得到支持。患有阿片类药物使用障碍和慢性疼痛的患者中阿片类药物的使用。总体而言，患者的疼痛结果有所改善，但这些改善并没有因治疗条件的不同而存在显着差异。
Aims: The primary study aim was to evaluate the feasibility and acceptability of cognitive-behavioral therapy (CBT) for opioid use disorder and chronic pain. The secondary aim was to examine its preliminary efficacy.Methods: In a 12-week pilot randomized clinical trial, 40 methadone-maintained patients were assigned to receive weekly manualized CBT (n = 21) or Methadone Drug Counseling (MDC) to approximate usual drug counseling (n = 19).Results: Twenty of 21 patients assigned to CBT and 18 of 19 assigned to MDC completed the pilot study. Mean (SD) sessions attended were 8.4 (2.9) for CBT (out of 12 possible) and 3.8 (1.1) for MDC (out of 4 possible); mean (SD) patient satisfaction ratings (scored on 1-7 Likert-type scales) were 6.6 (0.5) for CBT and 6.0 (0.4) for MDC (p < .001). The proportion of patients abstinent during the baseline and each successive 4-week interval was higher for patients assigned to CBT than for those assigned to MDC [Wald chi(2) (1) = 5.47, p = .02]; time effects (p = .69) and interaction effects between treatment condition and time (p = .10) were not significant. Rates of clinically significant change from baseline to end of treatment on pain interference (42.9% vs. 42.1%, [chi(2) (1, N = 40) = 0.002, p = 0.96]) did not differ significantly for patients assigned to CBT or MDC.Conclusions: We found support for the feasibility, acceptability, and preliminary efficacy of cognitive-behavioral therapy relative to standard drug counseling in promoting abstinence from nonmedical opioid use among patients with opioid use disorder and chronic pain. Overall, patients exhibited improved pain outcomes, but these improvements did not differ significantly by treatment condition.