Development and preliminary evaluation of an integrated cognitive-behavior treatment for chronic pain and substance use disorder in patients with the hepatitis C virus

Objective. 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. Design. Descriptive, including pretreatment, posttreatment, and follow-up testing. Setting and Patients. Outpatient clinic as part of one VA Medical Center. Participants. Veterans with chronic pain, SUD, and HCV. Intervention. Eight-session integrated group CBT for chronic pain and SUD in patients with HCV. Methods. Participants completed standardized measures of pain, function, depression severity, and alcohol and substance use at baseline, post-treatment, and 3-month follow-up. Results. 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. Conclusions. 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.