Brief Psychological Interventions for Reducing Prescription Opioid Use, Related Harm and Pain Intensity in Patients with Chronic Pain: A Systematic Review and Assessment of Patient Interest.

Elphinston, Rachel A; Sterling, Michele; Leung, Janni; Gray, Paul D; Requena, Simone Scotti; Connor, Jason P

OBJECTIVES Brief psychological interventions (BPIs) have demonstrated effectiveness in reducing substance use and related harm. No systematic review has examined their potential to reduce or prevent prescription opioid use or related harm, and/or pain intensity in opioid-using patients with chronic non-cancer pain (CNCP). Recognizing the importance of patient preferences in evidence-based practice, we also sought to assess patient interest in BPIs. METHODS A systematic review of studies published between 1980-2020 was conducted using five databases. Eligible treatment studies included patients ≥18 years old, with CNCP, and who were using prescription opioids. An adjunctive study independent of our review was also undertaken in 188 prescription opioid-using patients (77% female; Mage=49▒y) diagnosed with CNCP. Patients completed pain-related questionnaires online and indicated if they would consider BPI treatment options. RESULTS The review identified six studies. Given the heterogeneity across studies, a meta-analysis was not conducted. A narrative review found all of the six studies demonstrated some evidence for BPI effectiveness for reducing opioid use or related harms; these were assessed as having mostly low methodological quality. Mixed support for the effect on pain intensity was found in one study. Despite the inconclusive findings and heterogenous studies identified in the review, 92% of patients in our survey reported interest in receiving a BPI. DISCUSSION In combination, these findings highlight the inconsistency between patient demand and the availability of evidence for BPIs targeting opioid use, related harm and/or pain intensity. Future work should examine the effectiveness of BPIs in higher quality studies.