(52) Services for Treatment of Chronic Pain at Residential Substance Abuse Treatment Centers

Introduction/Background

The last decade has seen a rise in complications and deaths related to drug overdoses, including opioid overdoses. Residential treatment facilities can be used to treat substance use disorders and offer many modalities of treatment. Studies have shown that one of the risk factors for substance abuse is chronic pain. No previous studies have investigated the prevalence of chronic pain treatment as a component of residential substance abuse treatment, despite its importance in holistic treatment. This initiative seeks to investigate the prevalence of and describe the type of chronic pain services offered at these residential programs.

Methods

This study was a retrospective review of information publicly available on residential substance use facility treatment websites, obtained from SAMHSA’s treatment navigator. The navigator generated a total of 3307 facilities nationwide. 355 sites were excluded since they did not have websites listed. 600 sites were randomly selected for analysis. Prior to initiating the study, using 10 randomly selected websites, Fleiss’s kappa was calculated to measure interrater reliability between 4 abstractors. Our primary outcome was percent of facilities that had chronic pain programs. We also computed the following: percent of facilities that specified evidence-based treatment modalities for pain (such as yoga, physical therapy, massages, and exercise), percent of facilities that offered both pain services and adjunctive medical services (such as group therapy, nutritional guidance, spiritual therapy, cognitive behavioral therapy, and/or stress management), and percent of facilities that offered adjunctive services alone. Confidence intervals (95%) were indicated as appropriate.

Results

The kappa statistic for the data abstractors was 0.61, which represents substantial agreement. Due to overlap, 611 sites were reviewed. Of the randomly selected 611 sites, 585 (95.7%, [94,97]) were accessible. Of the 585 sites, 17 facilities (2.9%, [2,5]) had a chronic pain program. Fifteen (88.2%, [64,99]) of these facilities specified the pain and adjunctive services that were offered in their program. Pain services offered included yoga (4, 26.7%), 40% massage (6, 40%), and exercise (8, 53.3%). Adjunctive services offered included group therapy (8, 53.3%), nutritional guidance (7, 46.7%), spiritual therapy (7, 46.7%), and stress management (3, 20%). Of the remaining 568 sites, 418 (73.7%, [70,77]) specified offering adjunctive services. The most common services offered included group therapy (288, 68.9%, [64,73]), spiritual therapy (204, 48.8%, [44,54]), and cognitive behavioral therapy (101, 24.1%, [20,31]).

Conclusion

Our study demonstrated that despite the majority of sites offering adjunctive services, a very small percentage of residential treatment facilities had specific programs for treatment of chronic pain. It also suggests that evidence-based services for chronic pain may not be offered frequently. Given the link between substance use disorder and chronic pain, our study suggests that this is possibly an area where we can improve the care provided in residential treatment facilities. Future studies should further investigate whether or not there are discrepancies between the information available on facility websites and the services actually offered.
References

1) Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999–2019. NCHS Data Brief, no 394. Hyattsville, MD: National Center for Health Statistics. 2020.
2) McDermott, K. A., Griffin, M. L., McHugh, R. K., Fitzmaurice, G. M., Jamison, R. N., Provost, S. E., & Weiss, R. D. (2019). Long-term naturalistic follow-up of chronic pain in adults with prescription opioid use disorder. Drug Alcohol Depend, 205, 107675. doi:10.1016/j.drugalcdep.2019.107675
3) de Andrade, D., Elphinston, R. A., Quinn, C., Allan, J., & Hides, L. (2019). The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review. Drug and alcohol dependence, 201, 227–235.

Diversity, Equity, and Inclusion: We have demonstrated through our study that chronic pain treatment programs are not widely available in residential substance abuse treatment facilities. Our study may serve as the initiating point for addressing the need for chronic pain treatment widely in these treatment facilities, thus promoting health equity, and ultimately reducing healthcare disparities.