It's an unfortunate Catch-22: people trying to overcome addiction can't get treatment for pain because the most powerful pain medicines also carry an addiction risk.

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In many cases, then, a patient's discomfort continues amid their addiction recovery — or they seek relief with the very substances they're trying to avoid.

A new study shows the potential of a non-drug, low-cost approach that combines behavioral therapy and social support to facilitate pain management without medication.

Just 10 weekly sessions of a new approach known as ImPAT (Improving Pain during Addiction Treatment) had noticeable effects in 55 participating veterans, according to results published in the journal Addiction by a team from the VA Center for Clinical Management Research in Ann Arbor and the University of Michigan Addiction Center.

Veterans who received ImPAT care in combination with addiction treatment reported a decrease both in overall pain levels and alcohol intake — as well as an increase in function — compared to veterans that received a less-focused approach (peer-support groups led by a therapist). 

Because both parties were receiving addiction treatment, drug use declined similarly.

"These results highlight the need for addiction treatment programs to offer a multifaceted approach that doesn't only address substance use but also the other factors that might be driving substance use, including pain," says Mark Ilgen, Ph.D., the study's lead author and a VA and U-M psychologist specializing in addiction research.

"We've shown that it's possible to improve pain outcomes in people with addiction and even have some spillover effects on their substance use."

Caught in the middle

All 129 patients in the study, most of them men in their 40s and 50s, already were receiving outpatient addiction treatment at the Ann Arbor VA.

But addiction treatment programs, Ilgen says, often have patients who suffer from chronic pain but offer few options or providers trained to treat them.

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To make matters worse, he notes, "Past studies of psychosocial approaches for pain have often excluded people with drug or alcohol problems."

Which is why the sharp rise in opioid addiction in recent years — often among people who started taking the painkillers as treatment for acute or chronic pain — has made the search for effective non-drug pain treatment options even more urgent.

"Long-term use of opioids can sometimes lead to a hypersensitivity to pain, so there may actually be a causal link between use of these medications and pain," says Ilgen, also an associate professor of psychiatry and a member of the U-M Institute for Healthcare Policy and Innovation. "We need to study psychological pain management approaches in opioid-dependent patients, including those receiving addiction therapies such as buprenorphine."

A collaborative approach

By combining elements of cognitive behavioral therapy with another psychosocial approach called acceptance and commitment therapy, the ImPAT technique seeks to use integrated approaches to help patients fixate less on their pain and more on other aspects of life.

"We want to take the focus off pain and put it onto functioning and finding pleasurable ways to spend time," Ilgen says. "There's also a strong link between depression and pain. Pain is responsive to mood and mood is responsive to social support."

In an editorial accompanying the new paper, another addiction and pain specialist, William C. Becker, Ph.D. of Yale University and the Connecticut VA, notes that the new results are impressive — particularly because ImPAT was compared with another psychosocial approach.

And there is room to grow. The paper's researchers, including the U-M Addiction Center director and senior author Frederic Blow, Ph.D, have already launched a follow-up study in a larger group of 480 non-veterans in a residential addiction treatment program.

ImPAT, they note, has the potential to be easily and inexpensively adopted by addiction treatment centers and groups worldwide.