"Its a Catch with potentially deadly consequences People trying to overcome addiction cant get treatment for their pain because the most powerful pain medicines also carry an addiction risk.  And so their pain continues to get in the way of their addiction recovery  or they seek pain relief in the same addictive substances theyre trying to avoid.  But a new study shows the potential for patients to break out of that cycle through a nondrug approach that combines behavioral therapy and social support to help them manage their pain. The lowcost approach grounded in psychological theories of pain could help address the nations epidemic of addictions to opioid painkillers and illicit drugs. Veterans who received this painfocused care while also being treated for addiction found that the intensity of their pain decreased their ability to function increased and their alcohol use went down compared to veterans who received a lessfocused approach. However the two groups had similar rates of drug use. Just  weekly sessions of the approach called ImPAT for Improving Pain during Addiction Treatment had an effect that lasted up to a year in  veterans who took part according to the new results published in the journal Addiction by a team from the VA Ann Arbor Healthcare Systems Center for Clinical Management Research and University of Michigan Medical Schools Addiction Center.  The researchers have already launched a followup study in a larger group of  nonveterans in a residential addiction treatment program. And the studys authors note that the ImPAT approach has the potential to be easily and inexpensively adopted by addiction treatment centers and groups worldwide through team members trained in standard psychological techniques.  Caught in the middle  These results highlight the need for addiction treatment programs to offer a multifaceted approach that doesnt only address substance use but also the other factors that might be driving substance use including pain says Mark Ilgen Ph.D. the studys lead author and a VA and UM psychologist specializing in addiction research. Weve shown that its possible to improve pain outcomes in people with addiction and even have some spillover effects on their substance use. Addiction treatment programs often have patients who suffer from chronic pain but offer few options to treat them Ilgen says. To make matters worse Past studies of psychosocial approaches for pain have often excluded people with drug or alcohol problems addiction treatment programs do not usually have providers trained in pain care and many pain specialists will not treat people who also have addiction. So patients are caught in the middle. All  patients in the study most of them men in their s and s were receiving outpatient addiction treatment in a CBTbased nonabstinence setting at the Ann Arbor VA. Half were randomly assigned to ImPAT sessions the other half to support groups of peers led by a therapist where pain and addiction could be discussed.  Combination approach ImPAT combines elements of cognitive behavioral therapy with another psychosocial approach called acceptance and commitment therapy.  While the two approaches arent usually used together they are often used in pain treatment settings  but those clinics and programs dont often accept people who also acknowledge they have addiction issues. Ilgen and his colleagues hope their results will help bring the techniques into addiction treatment settings where the cognitive behavioral therapy approach is often used. The ImPAT technique seeks to use integrated approaches both to help patients focus less on their pain and more on other aspects of life. This includes techniques to help people adapt to their pain find ways to distract themselves from their pain and think of ways to function in the face of pain.  We want to take the focus off pain and put it onto functioning and finding pleasurable ways to spend time Ilgen says. Theres 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 even more impressive because ImPAT was compared with another psychosocial approach.  The newly published study did show that one in five veterans randomly assigned to ImPAT or the comparison approach did not actually attend any sessions  likely because of delays in getting the sessions going. The larger ongoing study based in an abstinencebased treatment facility in Michigan and funded by the National Institute on Drug Abuse has largely avoided that issue by decreasing the delay between study recruitment and the start of the treatment groups Ilgen says.  The study in veterans was planned just before the rapid rise in and increased awareness of opioid painkiller addiction issues in the U.S. While opioid addiction was one of the issues faced by veterans in the study most had issues with multiple substances.  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 nondrug pain treatment options even more urgent Ilgen notes.  Longterm 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 he notes. We need to study psychological pain management approaches in opioiddependent patients including those receiving addiction therapies such as buprenorphine. In the meantime he notes people struggling with addiction who want to seek relief from pain should explore the full range of treatment options that have been shown to work in nonaddicted patients including physical therapy exercise and psychotherapy as well as antidepressant medications. And while existing prescription guidelines do not explicitly prohibit the use of opioid painkillers in people with pain who have substance use disorders these guidelines recommend only using opioids sparingly and under close supervision he says. In addition to Ilgen an associate professor in the UM Department of Psychiatry and member of the UM Institute for Healthcare Policy and Innovation the study team included Addiction Center director Frederic Blow Ph.D. as well as Amy S. B. Bohnert Ph.D. Stephen Chermack Ph.D. Carly Conran Mary Jannausch M.S. and Jodie Trafton. Blow Bohnert and Chermack are all members of the VA CCMR and IHPI. The study was funded by the Veterans Health Administrations Health Services Research and Development Service Reference Addiction Volume  Issue  pages  August . doi.add. httponlinelibrary.wiley.comdoi.add.abstract  Editorial httponlinelibrary.wiley.comdoi.add.abstract"