Behavioral Treatments vs. Opioids: a Professor and Her Students Survey Chronic Pain Sufferers

Lisa McAndrew, who designed the study and collected the data from patients with chronic pain. (Photo by Brian Busher)

ALBANY, N.Y. (Feb. 27, 2020) — Chronic pain, a disabling health condition that various surveys have said affects anywhere from 50 million to 116 million Americans, is often treated with opioid pain medication. But there is little evidence of this treatment's long-term benefit, and it comes with the risks of addiction and harmful, even deadly, overdose.

Given the epidemic of opioid overdoses, Assistant Professor Lisa McAndrew of Educational & Counseling Psychology led a research team that surveyed chronic pain sufferers about behavioral therapies: how many were using them and how many were interested in pursuing them in lieu of opioids. The study, which interviewed more than 1,000 people with chronic pain, is now featured online in The Journal of Pain, a leading publication in the field. (It will also be included in the Journal’s upcoming print edition.)

The article, titled “Doctor recommendations are related to patient interest and use of behavioral treatment for chronic pain and addiction,“ incorporated the work of McAndrew, who designed the School of Education-funded study and collected the data, fellow department member Jessica Martin and two Ph.D. students, Margeaux Cannon and Alye Brunkow. The students were the lead authors of the piece, as well as contributors to the study's design and collection of data.

McAndrew’s expertise in the subject extends to her joint appointment with the War Related Illness and Injury Study Center at the Veterans Affairs New Jersey Health Care System. There, she is acting director of research and conducts federally funded clinical trials to develop behavioral treatments for veterans with complex post-deployment health concerns.

PhD student Margeaux Cannon (left) and Alye Brunkow were lead authors on the Journal of Pain article. (Photo at left by Brian Busher)

A Survey Indicates Patient Interest

Her team’s anonymous survey asked participants whether they had used, were interested in, or been recommended a range of behavioral treatments — such as cognitive-behavioral therapy or health coaching — or medication for chronic pain and addiction. The study found that patients overall were interested in non-medication treatment options for chronic pain, including those who may be at risk for misusing opioids — 63.67 percent of participants did screen positive for possible opioid misuse.

Other findings among the participants:

• 83.19 percent used medication for pain
• 85.05 percent were recommended used of medication by their doctors
• 67.45 percent used behavioral treatments
• 62.82 percent were recommended use of behavioral treatments by their doctors
• 63.67 percent screened positive for possible opioid abuse

“Those who screened positive [for opioid misuse] were more interested in receiving behavioral treatments than those who did not screen positive,” the study stated.

“The study findings highlight the association between doctor recommendation and patient interest and receipt of a treatment,” said McAndrew. “Our next study will be asking providers about their knowledge of behavioral treatments for pain and facilitators and barriers to providing them. Doctors should be encouraged to discuss non-medication treatment options for chronic pain management with their patients rather than assume patients prefer to treat chronic pain solely with medication.

“We need to look at how to support providers in providing these treatments."

McAndrew said her team has obtained funding to test the efficacy of some of the behavioral treatments patients were interested in receiving. “Our goal is to develop behavioral interventions patients with chronic pain want to receive,” she said.

Advantage for the Student Researcher

Co-author Cannon, a third-year PhD candidate, said she has benefitted from the research projects she’s engaged in, and the research skills and statistical techniques she’s acquired, by working with the McAndrew team. “It has allowed me to develop my own research agenda,” she said.

Supported by McAndrew, Cannon used the data from the chronic pain study to create a poster for last year’s American Psychological Association Convention in Chicago. It highlighted the high rate of opioid misuse present in the study’s sample and the relation between doctor recommendations for addiction treatment and patient interest. Her effort earned second place and a cash prize from the Society of Addiction Psychology.

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