PMID- 27149578
OWN - NLM
STAT- MEDLINE
DCOM- 20170920
LR  - 20181202
IS  - 1547-5069 (Electronic)
IS  - 1527-6546 (Linking)
VI  - 48
IP  - 4
DP  - 2016 Jul
TI  - Behavioral Interventions Targeting Chronic Pain, Depression, and Substance Use 
      Disorder in Primary Care.
PG  - 345-53
LID - 10.1111/jnu.12213 [doi]
AB  - BACKGROUND: Patients with chronic pain, depression, and substance use disorder 
      (SUD) are often treated in primary care settings. An estimated 52% of patients 
      have a diagnosis of chronic pain, 5% to 13% have depression, and 19% have SUD. 
      These estimates are likely low when considering the fact that 50% of primary care 
      patients with depression and 65% with SUD are undiagnosed or do not seek help. 
      These three conditions have overlapping neurophysiological processes, which 
      complicate the treatment outcomes of a primary physical illness. Behavioral 
      interventions have been widely utilized as adjunctive treatments, yet little is 
      known about what types of behavioral interventions were effective to treat these 
      comorbidities. This systematic review aimed to identify behavioral interventions 
      targeting chronic pain, depression, and SUD in primary care settings. METHODS: 
      The Cumulative Index to Nursing and Allied Health Literature, Medline, PsycInfo, 
      and Google Scholar databases were searched to identify randomized controlled 
      trials, using a behavioral intervention, involving adults with at least two of 
      the three conditions. RESULTS: This search yielded 1,862 relevant records, and 
      six articles met final selection criteria. A total of 696 participants were 
      studied. Behavioral interventions varied in content, format, and duration. 
      Mindfulness Oriented Recovery Enhancement (MORE), Acceptance and Commitment 
      Therapy (ACT), Interpersonal Psychotherapy adapted for pain (IPT-P), and 
      Cognitive Behavioral Therapy (CBT) showed promising improvements across all 
      studies, albeit with small to moderate effects. CONCLUSIONS: MORE, ACT, and CBT 
      combined with mindfulness and Motivational Interviewing had the most promising 
      results for treating chronic pain, depression, and SUD in various combinations in 
      primary care settings. CLINICAL RELEVANCE: The evidence is mounting that 
      behavioral interventions such as mindfulness-based or cognitive-behavioral 
      interventions are effective strategies for managing patients with comorbidities 
      of chronic pain, depression, and SUD in primary care. Integrated delivery of 
      behavioral interventions via group sessions, computers, and smart phones may 
      increase patient access to treatment; save time and cost; reduce stigma, patient 
      distress, family burden, and healthcare fragmentation; and provide a ray of hope 
      to amplify conventional treatments.
CI  - (c) 2016 Sigma Theta Tau International.
FAU - Barrett, Kathleen
AU  - Barrett K
AD  - Beta Omicron, Adjunct Assistant Professor, College of Health Sciences, Lienhard 
      School of Nursing, Pace University, Pleasantville, NY, USA.
FAU - Chang, Yu-Ping
AU  - Chang YP
AD  - Gamma Kappa, Associate Professor, School of Nursing, The State University of New 
      York at Buffalo, Buffalo, NY, USA.
LA  - eng
PT  - Journal Article
PT  - Review
PT  - Systematic Review
DEP - 20160505
PL  - United States
TA  - J Nurs Scholarsh
JT  - Journal of nursing scholarship : an official publication of Sigma Theta Tau 
      International Honor Society of Nursing
JID - 100911591
SB  - IM
MH  - Behavior Therapy/*methods
MH  - Chronic Pain/epidemiology/*therapy
MH  - Comorbidity
MH  - Depression/epidemiology/*therapy
MH  - Humans
MH  - *Primary Health Care
MH  - Randomized Controlled Trials as Topic
MH  - Substance-Related Disorders/epidemiology/*therapy
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Behavioral interventions
OT  - chronic pain
OT  - depression
OT  - primary care
OT  - substance use disorders
EDAT- 2016/05/06 06:00
MHDA- 2017/09/21 06:00
CRDT- 2016/05/06 06:00
PHST- 2016/03/07 00:00 [accepted]
PHST- 2016/05/06 06:00 [entrez]
PHST- 2016/05/06 06:00 [pubmed]
PHST- 2017/09/21 06:00 [medline]
AID - 10.1111/jnu.12213 [doi]
PST - ppublish
SO  - J Nurs Scholarsh. 2016 Jul;48(4):345-53. doi: 10.1111/jnu.12213. Epub 2016 May 5.