540) High dose opioid weaning within the context of a chronic pain rehabilitation program

s The Journal of Pain S111 (540) High dose opioid weaning within the context of a chronic pain rehabilitation program T Rush, K Huffman, M Mathews, G Sweis, B Vij, J Scheman, and E Covington; Cleveland Clinic Foundation, Cleveland, OH Research supports weaning patients from chronic opioid therapy (COT) in the context of an interdisciplinary chronic pain rehabilitation program (CPRP). The aim of the current study was to examine CPRP outcomes for patients with chronic non-cancer pain (CNCP) weaned off high-dose COT (HD; >100mg morphine equivalency dose-MED). Outcomes for these patients were compared with patients weaned from low-dose COT (LD, 0.01-99.9mg MED) and patients not on COT (ND). Data was available from 1248 patients admitted to a CPRP between 2007-2011. Cases were included in analyses if patients completed the program (81% n=1016), were on COT at admission (53%, n=659), and were fully opioid weaned upon discharge (n=557). This resulted in inclusion of 527 patients: 231 HD, 296 LD and 331 ND. Participants were predominately married (60%) females (65.7%) with a mean age of 42.2 (613.8); however, patients in the HD group were more likely to be male (43%, p<.05). Outcome variables, including pain, functional impairment, depression and anxiety, were assessed at admission, discharge, 6 months and 12 months post-treatment. A one-way repeated measures MANOVA was used to assess outcomes at each time point. Results showed thatwhile the HDgroup reported significantly higher levels of depression at admission (p=.01), at discharge all groups reported clinically and statistically significant improvements in pain severity (-50%, p<.01), pain related functional impairment (-59%, p<.01), normalization of depression (-69%, p<.01) and anxiety (-52%, p<.01). Significant treatment benefits were still observed at both 6 and 12 months. No differences in benefits were observed as a function of opioid dosing group. Results demonstrate that patients on high dose opioids can be successfully weaned from COT and obtain similar treatment benefits as their LD and ND counterparts, with significant improvements in depression, anxiety, pain severity, and pain-related functional impairment. (541) Guiding parent responses to their child’s pain during intensive interdisciplinary pediatric pain rehabilitation D Wallace, M Fitzgerald, R Anderson, B Woodford, and C Hoffart; Children’s Mercy Hospital, Kansas City, MO Parental responses to their child’s pain, particularly protective responses, are associated with the young person’s pain-related impairment, pain complaints, mood, and engagement in social activities. Research suggests these responses maybe affectedby the parent’s feelings of distress and helplessness, parent catastrophizing, and parent attributions about the cause of symptoms. However, few studies have investigated the effect of pediatric pain rehabilitation on parental responses or directly targeted these potential contributors to parent responses. While their adolescent children (ages 11-18) participated in a 3-6 week intensive interdisciplinary pediatric pain rehabilitation program, all 22 parents (primarily mothers) consistently attended two 60-90 minute parent groups per week led by a psychologist or social worker. Groups maintained a supportive and educational format, and parents were encouraged to share challenges of parenting a teen with pain, while also being prompted to interact with a specific topic each session (e.g. coping with own emotions, responding to teen pain, promoting appropriate teen independence, behavior management, and education about chronic pain). One parent fromeach family completed measures at baseline, the end of each week of treatment, and onemonth follow-up, including the Adult Responses to Children’s Symptoms (ARCS) and the parent Functional Disability Inventory (FDI-parent). Teens reported their pain on a 100mm visual analog scale. Results indicate, on average, both parent protective and monitoring responses declined throughout the program (t=5.37; p<.001; t=6.18; p<.001, respectively) and these effects were maintained at follow-up. FDI-parent was somewhat associated with protective andmonitoring parent responses at baseline (p’s<.05), but only with protective responses at program end (p<.05). Child pain was not associated with parent responses. In conclusion, parent groups during intensive interdisciplinary pediatric pain rehabilitation may be an effective format to target parent responses to their child’s pain, and these effects are not solely explained by improvements in child disability or pain. (542) "Just because I’m an addict, doesn’t mean I don’t have pain": healthcare experiences of those with coexisting substance use disorder and chronic pain B St Marie; University of Iowa, Iowa City, IA This is a qualitative study examining the narratives of people who experience chronic pain and are receiving methadone for the treatment of the opiate addiction through a methadone clinic as they experience encounters with healthcare facilities and providers. The purposefully selected sample was composed of 34 patients who experienced pain for more than 6 months, were receiving methadone for treatment of opiate addiction from a methadone clinic in a Midwest metropolitan area, and were willing to tell the story of their experiences. Participants were asked to describe their healthcare experiences when seeking help to manage these two conditions. The primary datacollection method was in-depth interviews. Thematic analysis and structural analysis were used to find themes in the narrative content, and to understand the evolution and meaning of the story. The participants revealed how the healthcare system did not meet their needs. The medical history of substance use disorderwas not considered during examination or treatment of pain. Stigmatizing treatment made participants want to abuse opioids again. Participants provided recommendations on how best to treat their pain. The outcomes of this study provided knowledge of how negative healthcare encounters can impact the patient with coexisting substance use disorder and pain in a very harmful ways. The participants in this study provided reasonable recommendations for healthcare providers in caring for individuals with coexisting substance use disorder and pain. (543) Acceptance and Commitment Therapy for chronic pain: a diary study of treatment process in relation to reliable change in disability K Vowles, B Fink, and L Cohen; University of New Mexico, Albuquerque, NM In chronic pain treatment, a chief goal is reduced disability. It is often assumed that a primary process by which disability reduction occurs is pain reduction. Conversely, approaches such as Acceptance and Commitment Therapy (ACT) posit that pain reduction is not necessary to achieve reduced disability. Instead, disability reduction occurs when responses to pain are changed, such that unsuccessful struggles for pain control decrease and engagement in personallyvalued activities increase. While treatment outcome studies have supported ACT’s effectiveness, less work has examined how within-treatment patterns of change relate to treatment success or failure (i.e., decreased or sustained disability). The present study, therefore, sought to examine this issue. Specifically, struggles for pain control and engagement in valued activities were recorded weekly in 21 patients who completed a four week interdisciplinary ACT intervention for chronic pain. It was hypothesized that successful treatment, defined in this case as reliable change in disability at three month follow-up, would be associated with a within-treatment pattern of change which included both decreases in pain control efforts and increases in valued activity. At follow-up, 47.6%of patients evidenced reliable disability reduction. The expected pattern of change occurred in 81.0% of patients – specifically, when pain control attempts decreased and engagement in valued activities increased, reliably reduced disability typically occurred, while the absence of this pattern was typically associated with a lack of reliable change. Further, changes in pain intensity, also assessed weekly, were unrelated to reliable change in disability. Overall, these results provide additional support for the ACT model and further suggest some possible requirements for treatment success.