Persistent pain and opioid dependence. The evidence for psychological treatment approaches

Research has demonstrated cognitive and behavioural therapies are effective psychological treatments for patients diagnosed with chronic or persistent pain. Diagnosing persistent pain can be a lengthy process of investigation and often during this process analgesics are prescribed to reduce the level of pain and discomfort experienced by patients. The growth in the number of prescribed opioids for persistent pain has increased rapidly in Australia and Tasmania, with much of this growth attributed to treating persistent pain. Despite this there is limited evidence supporting the long term use of opioid analgesics in persistent pain. Research however, shows that psychological therapy contributes more to improving a person’s functioning and self-management of their persistent pain. Using a biopsychosocial framework psychologists work with clients to actively manage their pain so that they may reduce their reliance on medications. It is not clear from the literature whether this approach remains effective when the patient already presents with a dependence on their opioid medications. The aim of this study was to systematically review the literature to identify the most effective interventions in treating patients presenting with opioid dependence and persistent pain. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted to conduct the systematic review. A number of databases were searched including Pubmed, Cochrane, Web of Science and PsychArticle databases with search terms consisting of “persistent or chronic pain”, in combination with “opioid treatment and dependence”, and “psychological treatment, or therapy, or intervention.” Best practice guidelines for psychologists to follow when presented with a patient diagnosed with persistent pain concurrently being managed by opioid medications are presented and discussed.