Disparities in access but not outcomes: Medicaid versus non-Medicaid patients in multidisciplinary chronic pain rehabilitation.

Purpose: There are known disparities in chronic pain severity, treatment, and opioid-related risks amongst individuals from lower socioeconomic status, including Medicaid beneficiaries, but little is known about whether Medicaid beneficiaries benefit in a similar way from multidisciplinary chronic pain rehabilitation. This study investigated differences in clinical outcomes between Medicaid and non-Medicaid beneficiaries who completed a 3-week multidisciplinary chronic pain rehabilitation program.Methods: Participants (N = 131) completed a broad range of clinical measures pre- and post-treatment including pain severity, pain interference, depression, anxiety, objective physical functioning, and opioid misuse risk. Patients with Medicaid were compared with non-Medicaid patients in terms of baseline characteristics and rate of change, utilizing two-factor repeated measures analyses of variance.Results: There were baseline characteristic differences, with Medicaid beneficiaries being more likely to be African American, have higher rates of pain, worse physical functioning, and lower rates of opioid use. Despite baseline differences, both groups demonstrated significantly improved outcomes across all measures (p<.001) and no significant difference in rate of improvement.Conclusions: Results suggest that pain rehabilitation is as effective for Medicaid recipients as non-Medicaid recipients. Patients with Medicaid are particularly vulnerable to disparities in treatment, so efforts to expand access to multidisciplinary pain treatments are warranted.

Medicaid beneficiaries, who tend to be from lower socioeconomic status (SES), with chronic pain have poorer baseline functioning compared to non-Medicaid beneficiaries, including worse pain severity, poorer physical functioning, and higher levels of anxiety.Medicaid beneficiaries appear to benefit significantly and in a similar way to non-Medicaid individuals from participating in multidisciplinary, non-pharmacological chronic pain rehabilitation.Expanding access to evidence-based chronic pain rehabilitation, including nonopioid and multidisciplinary treatments, is a key component to address the chronic pain and opioid crises that differentially impact individuals from lower SES.

Patient Motivation to Reduce or Discontinue Opioids for Chronic Pain: Self-efficacy, Barriers, and Readiness to Change.

OBJECTIVES: This study aimed to assess levels and predictors of self-efficacy and motivation to change opioid use among a community sample of patients using opioids for chronic pain, as well as patient-reported barriers to pursuing opioid discontinuation. METHODS: Participants with a variety of chronic pain conditions, recruited from ResearchMatch.org , completed a battery of electronic, self-report questionnaires assessing demographic and medical characteristics, pain treatment history, and levels of readiness, self-efficacy, and other attitudes toward reducing or discontinuing opioid use. Multiple regression analyses and analyses of variance were conducted to examine predictors of readiness and self-efficacy to change opioid use. A modified version of rapid qualitative analysis was utilized to analyze themes in participant responses to an open-ended item about "what it would take" to consider opioid discontinuation. RESULTS: The final sample included N=119 participants, the majority of whom were female (78.2%), Caucasian (77.3%), and well-educated. Readiness and self-efficacy to decrease or stop opioid use were fairly low on a 0 to 10 Visual Analog Scale (2.6 to 3.8) and significantly higher to decrease than stop ( P <0.01). Higher readiness to change was predicted by lower pain severity and higher concern about opioids, whereas higher self-efficacy was predicted by shorter pain duration. Results from the qualitative analyses revealed that the availability of an alternative treatment option was the most commonly cited requirement to consider opioid discontinuation. DISCUSSION: Patients with lower pain severity, shorter duration of pain, and higher concerns about opioids may be a prime target from a motivation standpoint for interventions addressing opioid tapering and discontinuation.

Gender-specific correlates of nonmedical use of prescription medications in a diverse primary care sample.

BACKGROUND: Nonmedical use of prescription medications (NUPM) is a growing problem but little is known about its gender-specific mechanisms despite NIDA's call for gender-stratified research over a decade ago. We explored gender differences in NUPM in a diverse sample of primary care patients. METHODS: N = 4458 participants participated in an anonymous health survey in urban primary care clinics. The primary outcome was past month NUPM. All analyses were stratified by gender. Bivariate relationships among NUPM and demographic, medical, psychological, and substance use-related variables were analyzed. Stepwise multivariate logistic regression models (LRMs) were estimated by gender. RESULTS: More men (9.5%) reported NUPM than women (7.4%). The final LRM among men included age (OR=0.98), race (OR=0.49), chronic pain diagnosis (OR=1.73), hepatitis (OR=1.78), depression diagnosis (OR=1.77), positive alcohol misuse screen (OR=1.58), and mood disturbance (OR=1.04). Among women, the model included mood disturbance (OR=1.04), illicit drug use (OR=2.22), family history of drug problems (OR=1.41), and heart disease diagnosis (OR=0.48). Effect sizes ranged from small to moderate. CONCLUSIONS: Among a sample of primary care patients, gender-stratified analyses indicated differential presentation of NUPM by gender. Demographic factors were more relevant correlates among men, with younger, White men at higher risk. Chronic pain and depression were more notable risk factors for men. Recent illicit drug use and family history of drug problems were uniquely associated among women, while recent distress was a strong correlate among both men and women. A better understanding of gender-specific correlates of NUPM can inform gender-tailored prevention and treatment efforts.

Pain rehabilitation's dual power: Treatment for chronic pain and prevention of opioid-related risks.

The purpose of this article is to provide a data-driven exploration of an interdisciplinary pain rehabilitation program (PRP) as a viable option for addressing the dual crises of chronic pain and opioid use. Psychologists are crucial providers in the PRP, in both intervention and leadership roles. There is well-established literature supporting pain rehabilitation as an effective treatment for chronic pain and functioning, but there are few studies examining the effects of pain rehabilitation on opioid misuse risk. We evaluated data from 60 patients with diverse chronic pain conditions who completed an interdisciplinary PRP to evaluate changes in pain, functioning (self-report and objective physical measure), psychological symptoms, and health-related quality of life. To evaluate the effect of pain rehabilitation on opioid-related risks, we examined opioid use and opioid misuse behaviors (measured by the Current Opioid Misuse Measure; COMM) pre- and posttreatment. Results demonstrated statistically significant improvements in all outcomes, with medium effect sizes for pain severity and large effect sizes for functioning, psychological symptoms, and emotional quality of life. Fifty-eight percent of patients were on opioid medications at entry compared with 15% at discharge. Among patients who entered on opioids, mean COMM scores were significantly reduced from above the cutoff for misuse risk (M = 13.57) to below the cutoff (M = 5.86). Overall, this study provided strong support for pain rehabilitation as an effective treatment for chronic pain and related suffering, while also providing a prevention-based opportunity for reducing opioid-related risk. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Adaptation of behavioral activation in the treatment of chronic pain.

Chronic pain is a common problem that can be challenging to treat because of its complex history, unclear etiology, and poor response to traditional treatment approaches. A growing body of research suggests that behavioral activation (BA), which was originally developed as a treatment for depression, may be a promising treatment for chronic pain. BA involves the identification and enactment of activities that are reinforcing to the individual and consistent with his or her long-term goals. The application of BA for the treatment of chronic pain is fully consistent with models of chronic pain which post that fear and avoidance leads to a cycle of physical deconditioning, increased pain as a result of deconditioning, lack of positive reinforcement, and low mood, and further reduced motivation to physically engage. The present paper will detail the assessment and use of BA to treat "Veteran," a patient with low back and bilateral foot pain. This case study highlights how gradually increasing engagement in previously avoided activities can help disrupt the harmful cycle among pain, fear and avoidance, and mood. The implication of the outcomes from this case study for future psychotherapy research on chronic pain is also discussed. (PsycINFO Database Record