title: Development and Preliminary Evaluation of an Integrated Cognitive-Behavior Treatment for Chronic Pain and Substance Use Disorder in Patients with the Hepatitis C Virus.
abstract: Individuals with the hepatitis C virus (HCV) have high rates of both chronic pain and substance use disorder (SUD). Despite high comorbidity, there are limited data available on effective methods of treatment for co-occurring chronic pain and SUD. In this study, we sought to develop and conduct preliminary testing of an integrated cognitive-behavior therapy (CBT) for chronic pain and SUD in patients with HCV.
  
  
  
  Descriptive, including pretreatment, posttreatment, and follow-up testing.
  
  
  
  Outpatient clinic as part of one VA Medical Center.
  
  
  
  Veterans with chronic pain, SUD, and HCV.
  
  
  
  Eight-session integrated group CBT for chronic pain and SUD in patients with HCV.
  
  
  
  Participants completed standardized measures of pain, function, depression severity, and alcohol and substance use at baseline, post-treatment, and 3-month follow-up.
  
  
  
  Generalized estimating equations identified improvements in pain interference, reducing cravings for alcohol and other substances, and decreasing past-month alcohol and substance use. The proportion of participants who met diagnostic criteria for current SUD demonstrated a four-fold decrease over the course of the study from 24% at baseline to 15% at post-treatment and 6% at 3-month follow-up. On response to a global impression of change, 94% of participants noted improvement from baseline.
  
  
  
  Results from this pilot study suggest that a customized CBT for patients with both chronic pain and SUD (CBT-cp.sud) may be beneficial in improving important pain and addiction-related outcomes in patients with HCV. Larger scale investigations of this intervention appear warranted.
authors.affiliation: *Center to Improve Veteran Involvement in Care benjamin.morasco@va.gov.|Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Oregon.|Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Morasco
authors.affiliation: Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Oregon.|Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
authors.forename: David W
authors.initials: DW
authors.lastname: Greaves
authors.affiliation: *Center to Improve Veteran Involvement in Care.|Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Oregon.|Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
authors.forename: Travis I
authors.initials: TI
authors.lastname: Lovejoy
authors.affiliation: Department of Anesthesiology and Pain Medicine and Center for Pain Research on Impact, Measurement, & Effectiveness, University of Washington, Seattle, Washington.
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Turk
authors.affiliation: *Center to Improve Veteran Involvement in Care.|Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, Oregon.|Department of Psychiatry, Oregon Health & Science University, Portland, Oregon.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
authors.affiliation: VISN 22 Network Office and Division of Mental Health, Long Beach VA Medical Center, California.|Department of Psychiatry, University of California San Diego.|Department of Psychiatry and Human Behavior, University of California-Irvine, California, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Hauser
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000534:rehabilitation; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019966:Substance-Related Disorders / Q000150:complications* / Q000534:rehabilitation*; D014728:Veterans
keywords: Chronic Pain; Cognitive-Behavior Therapy; Hepatitis C Virus; Integrated Treatment; Substance Use Disorder