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

• pain severity, as measured by the West-Haven-Yale Multidimensional Pain Inventory (WHYMPI) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  
• pain interference behaviors, as measured by the West-Haven-Yale Multidimensional Pain Inventory (WHYMPI) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  
• aberrant drug-related behaviors, assessed via the Current Opioid Misuse Measure (COMM) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  

• aberrant drug-related behaviors, as assessed by physicians via the Addiction Behavior Checklist (ABC) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  
• substance misuse, as measured by the Individual Assessment Profile (IAP) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  
• psychiatric distress, assessed via the SCL-10R [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  
• HIV risk behavior [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  
• quality of life, as measured by the World Health Organization Quality of Life-BREF (WHOQOL-BREF) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  
• positive affect, assessed via the positive affect subscale of the Positive Affect Negative Affect Scale (PANAS) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  
• satisfaction with pain treatment, measured via the Pain Service Satisfaction Test (PSST) [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  

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.