Cognitive-Behavioural and Other Psychosocial Approaches for Patients with Chronic Pain and Substance Abuse Problems
Managing chronic pain is challenging and further complicated in patients with substance abuse problems. There is growing evidence supporting the efficacy of psychological approaches to pain management. In most cases, psychological approaches for pain management are applied as an adjunct to medication management for pain. For patients with pain and substance abuse problems, psychological strategies for pain management may serve a more central role. Despite efficacious psychosocial pain management interventions and advancing medication management for pain, there is evidence that chronic pain cannot be adequately managed and may progress in the context of substance abuse problems. For this reason, the care of patients with chronic pain and substance abuse problems must be carefully coordinated to meet the multiple needs of the patient. Pain management in the context of substance abuse problems may be best conceptualized within the biopsychosocial model of pain. The biopsychosocial model of pain emphasizes that pain is a biological, psychological, and social experience. Within this model, pain management is approached by simultaneously addressing pain through biological, psychological, and social mechanisms. Several psychosocial approaches to pain management have been developed, tested, and shown efficacious for reducing pain, pain-related disability, and psychological distress. In this chapter, we present information on pain management in patients with chronic pain and substance abuse problems from a biopsychosocial perspective, emphasizing work in psychosocial pain management strategies, behavioral strategies for substance abuse problems, and possible strategies for integrating the two.
