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Psych Congress  

Chronic Pain Patients on Opioids—Examining the Impact on Pain and Mental Illness Symptoms After a 30-Day WILD 5 Wellness-Based Intervention

Rakesh Jain, MD, MPH; Saundra Jain, MA, PsyD, LPC

This poster was presented at the 30th annual  Psych Congress, held Sept. 16-19, 2017, in New Orleans, Louisiana.

Introduction: Opioid medications are often utilized in treating chronic pain (defined as pain more days than not for 6 months or longer), particularly when it overlaps with a psychiatric disorder. The President of the United States recently declared a national emergency regarding opioid medication use and abuse in the country. There is a national level push to diminish opioid use and help chronic pain patients through other modalities. Wellness-based interventions have traditionally not been utilized in helping chronic pain patients that are currently taking opioid medications. WILD 5 Wellness is a 30-day program that combines five interventions and tracks multiple markers over this time to assess for outcomes in these patients.

Methods: Five well-studied wellness interventions were utilized in this study. These interventions included - physical exercise (30-minutes a day), mindfulness-based meditation (at least 8-minutes a day), social connectedness enhancement activities, sleep hygiene interventions, and optimizing nutritional recommendations (including daily tracking of meals). Individuals were asked to sign consent, and then given a workbook containing educational materials, as well as a tracking form to measure daily compliance. Prior to starting the study, participants were asked to fill out multiple rating instruments, and at the end of the 30-day intervention, the scales were filled out again. The pre- and post-data was captured and analyzed using the StatPlus statistical package and within group measures were utilized using ANCOVA analysis with a p value set at p<0.05. The scales used in this study were the following - PHQ-9 for the measurement of depression; GAD-7 for the measurement of anxiety, PSQI for the measurement of sleep quality; MIND Diet score for the measurement of compliance with a Mediterranean-based brain healthy diet; MAAS for the measurement of mindfulness; SCS for the measurement of social connectedness, and BPI for the measurement of eight separate elements of chronic pain.

Findings: 19 individuals with chronic pain, who were also taking opioid medications were recruited from private practices from around the nation. There were participants from Texas, California, Oregon, and Canada. The following changes were found at the end of this 30-day wellness program (WILD 5 Wellness Program). Depression, as measured by PHQ-9, improved from a mean score of 13.1 to 6.5 (p<0.0001); Anxiety, as measured by GAD-7, improved from a mean score of 11.2 to 6.2 (p<0.001); Mental Wellness, as measured by the WHO-5, improved from a mean score of 7.5 to 13.4 (p<0.0001). There was a statistically significant positive impact on chronic pain. BPI - Worst Pain improved from a mean score of 6.7 to 5.3 (p<0.05); BPI - Average Pain improved from a mean score of 4.4 to 3.7 (p<0.05) and BPI - General Activities improved from a mean score of 5.3 to 4.3 (p<0.05).

Conclusion: Wellness interventions, such as the WILD 5 Wellness Program, is effective in chronic pain patients that are currently taking opioid medications. Non-pharmacological techniques can both improve the mental health and pain/functionality even in 'tough to treat' chronic pain patients taking opioid medications.

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