Outcomes of Psychotherapy for Co-Morbid Pain and Substance Use Disorders: A Review of the Literature

Chronic pain is often treated with opioids, placing patients at risk for misuse. An estimated 11.5% of these patients engage in opioid misuse behaviors such as self-medication. Non-pharmacological interventions have efficacy in managing chronic pain and substance use disorders separately; comorbid management may benefit from psychotherapy. This review provides perspective on novel and existing therapies and their efficacy. The literature search was conducted using PubMed. Boolean search terms were selected from DSM and ICD diagnoses. Studies were included if patients had comorbid substance use disorder and chronic pain diagnoses, participants were age 18 or older, and psychotherapeutic interventions were implemented. The PubMed search yielded 1937 references; 25 references were obtained through other means. 30 sources met inclusion criteria. Reported trials included: Acceptance and Commitment Therapy (ACT, 2 trials); Cognitive Behavioral Therapy (CBT, 11 trials); Mindfulness-Oriented Recovery Enhancement (MORE, 5 trials); and novel psychotherapies (12 trials). Unique features included primary care (4 trials), technology such as phone or Internet (6 trials), and group settings (9 trials). Several psychotherapies effectively treat co-occurring substance use disorders and chronic pain; novel treatments continue to be developed. Further investigation may lead to a wider variety of treatments for clinical use.