Abstract
Non-pharmacological chronic pain treatments increasingly incorporate values-based approaches as an alternative to opioid therapy. Chronic pain and opioid use may differentially impact value domains such as family or work, and there is little guidance on how to implement values-based treatment to address pain and comorbid opioid use. This study aims to characterize ways in which chronic pain and values interact. Participants (N = 327) 18 or older (M = 46 years) experiencing chronic musculoskeletal pain for > 3 months and actively taking a prescription opioid completed an online, self-report survey assessing the importance of values in six domains (i.e., family, intimate relationships, friendship, work, health, growth). Participants responded to questions about pain interference with and without opioids, and subjective impact of pain within each value domain. There were significant differences between the six value domains in importance ratings. Pain interference also differed among the values with the most reported pain interference occurring in the work and health domains. Pain interference without opioids was significantly greater for work, health, and family than the other values. The subjective impact of pain interference was greatest for family, work, and health as well. Across all value domains, pain interference without opioids was significantly greater than pain interference with the use of opioids. Results highlight that value domains are differentially impacted by chronic pain and opioids are perceived as reducing pain interference across all values. These results provide an initial description from which theory and hypotheses can be developed. Clinical implications and future directions are discussed.
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References
Becker, W. C., Dorflinger, L., Edmond, S. N., Islam, L., Heapy, A. A., & Fraenkel, L. (2017). Barriers and facilitators to use of non-pharmacological treatments in chronic pain. BMC Family Practice, 18, 41. https://doi.org/10.1186/s12875-017-0608-2
Bevers, K., Watts, L., Kishino, N. D., & Gatchel, R. J. (2016). The biopsychosocial model of the assessment, prevention, and treatment of chronic pain. US Neurology, 12, 98. https://doi.org/10.17925/USN.2016.12.02.98
Bosch, S. J., & Lorusso, L. N. (2019). Promoting patient and family engagement through healthcare facility design: A systematic literature review. Journal of Environmental Psychology, 62, 74–83. https://doi.org/10.1016/j.jenvp.2019.02.002
Dahlhamer, J., Lucas, J., Zelaya, C., et al. (2018). Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. MMWR, 67, 1001–1006.
Gatchel, R. J., McGeary, D. D., McGeary, C. A., & Lippe, B. (2014). Interdisciplinary chronic pain management: Past, present, and future. American Psychologist, 69, 119–130. https://doi.org/10.1037/a0035514
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: Understanding and treating human suffering. Guilford Press.
IPRC Committee. (2016). National pain strategy: A comprehensive population health-level strategy for pain. IPRC Committee.
Jensen, M. P., Nielson, W. R., & Kerns, R. D. (2003). Toward the development of a motivational model of pain. Journal of Pain, 4, 477–492. https://doi.org/10.1067/S1526-5900(03)00779-X
Kerns, D., & Turk, D. C. (1985). The West Haven–Yale Multidimensional Inventory (WHYMPI). Pain, 23, 345–356.
Kuehn, B. (2017). NIH strategy to combat opioid crisis. JAMA, 318, 2418. https://doi.org/10.1001/jama.2017.19920
Lardon, A., Dubois, J., Cantin, V., Piché, M., & Descarreaux, M. (2018). Predictors of disability and absenteeism in workers with non-specific low back pain: A longitudinal 15-month study. Applied Ergonomics, 68, 176–185. https://doi.org/10.1016/j.apergo.2017.11.011
Litman, L., Robinson, J., & Abberbock, T. (2017). TurkPrime.com: A versatile crowdsourcing data acquisition platform for the behavioral sciences. Behavior Research Methods, 49, 433–442. https://doi.org/10.3758/s13428-016-0727-z
Mafi, J. N., McCarthy, E. P., Davis, R. B., & Landon, B. E. (2013). Worsening trends in the management and treatment of back pain. JAMA Internal Medicine, 173, 1573. https://doi.org/10.1001/jamainternmed.2013.8992
McCracken, L. M., & Vowles, K. E. (2008). A prospective analysis of acceptance of pain and values-based action in patients with chronic pain. Health Psychology, 27, 215–220. https://doi.org/10.1037/0278-6133.27.2.215
McCracken, L. M., & Yang, S.-Y. (2006). The role of values in a contextual cognitive–behavioral approach to chronic pain. Pain, 123, 137–145. https://doi.org/10.1016/j.pain.2006.02.021
Moreno, J. L., Nabity, P. S., Kanzler, K. E., Bryan, C. J., McGeary, C. A., & McGeary, D. D. (2019). Negative life events (NLEs) contributing to psychological distress, pain, and disability in a US Military sample. Military Medicine, 184, e148–e155. https://doi.org/10.1093/milmed/usy259
Overaas, C. K., Johansson, M. S., de Campos, T. F., et al. (2017). Prevalence and pattern of co-occurring musculoskeletal pain and its association with back-related disability among people with persistent low back pain: Protocol for a systematic review and meta-analysis. Systematic Review, 6, 258. https://doi.org/10.1186/s13643-017-0656-7
SAS Institute. (2013). SAS Enterprise Miner 13.1. SAS Institute (Published online).
Saunders, S., Nedelec, B., & MacEachen, E. (2018). Work remains meaningful despite time out of the workplace and chronic pain. Disability and Rehabilitation, 40, 2144–2151. https://doi.org/10.1080/09638288.2017.1327986
Simon, L. S. (2012). Relieving pain in America: A blueprint for transforming prevention, care, education, and research. Journal of Pain and Palliative Care Pharmacotherapy, 26, 197–198.
Stumbo, S. P., Yarborough, B. J. H., McCarty, D., Weisner, C., & Green, C. A. (2017). Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement. Journal of Substance Abuse Treatment, 73, 47–54. https://doi.org/10.1016/j.jsat.2016.11.003
Theis, K. A., Roblin, D. W., Helmick, C. G., & Luo, R. (2018). Prevalence and causes of work disability among working-age US adults, 2011–2013, NHIA. Disability and Health Journal, 11, 108–115. https://doi.org/10.1016/j.dhjo.2017.04.010
Tournebize, J., Gibaja, V., Muszczak, A., & Kahn, J.-P. (2016). Are physicians safely prescribing opioids for chronic noncancer pain? A systematic review of current evidence. Pain Practice, 16, 370–383. https://doi.org/10.1111/papr.12289
Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: A state of the art. Pain, 85, 317–332.
Vlaeyen, J. W. S., & Linton, S. J. (2012). Fear-avoidance model of chronic musculoskeletal pain: 12 Years on. Pain, 153, 1144–1147. https://doi.org/10.1016/j.pain.2011.12.009
Vowles, K. E., McCracken, L. M., & O’Brien, J. Z. (2011). Acceptance and values-based action in chronic pain: A three-year follow-up analysis of treatment effectiveness and process. Behavioural Research Therapy, 49, 748–755. https://doi.org/10.1016/j.brat.2011.08.002
Wetherell, J. L., Afari, N., Rutledge, T., et al. (2011). A randomized, controlled trial of acceptance and commitment therapy and cognitive–behavioral therapy for chronic pain. Pain, 152, 2098–2107. https://doi.org/10.1016/j.pain.2011.05.016
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This project was supported by a Small Institutional Pilot-Project Grant from the Long School of Medicine at UT-Health San Antonio and by the Interprofessional Advanced Fellowship in Addiction Treatment at the South Texas Veterans Health Care System.
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EL: study design, data collection, analysis, manuscript writing, interpretation of results. DER: analysis, manuscript writing, interpretation of results. DM: study conceptualization, manuscript writing, review and editing, interpretation of results. BH: data collection, review and editing. JR: study conceptualization, manuscript writing, review and editing, interpretation of results.
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Elizabeth Lehinger, David E. Reed, II, Donald D. McGeary, Brittany N. Hager, and John D. Roache declare that they have no conflict of interest.
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This study was approved by the Institutional IRB Committee at UT Health San Antonio.
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Lehinger, E., Reed, D.E., McGeary, D.D. et al. Impact of Chronic Pain and Perceived Opioid Benefit on Value Domains. J Clin Psychol Med Settings 29, 689–698 (2022). https://doi.org/10.1007/s10880-022-09889-2
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DOI: https://doi.org/10.1007/s10880-022-09889-2