The release focuses on a recently published journal article that reported patients with chronic pain who are fighting drug addiction can reduce their pain using an approach called Improving Pain during Addiction Treatment (ImPAT).
The release notes that the intensity of pain decreased, alcohol use decreased, and ability to function increased, for patients participating in ImPAT when compared to patients who participated only in conventional support groups. Rates of drug use were approximately the same for both groups.
While the release does a good job of explaining why non-drug therapies are important for patients with chronic pain and a history of addiction, it does not meet our standard for telling readers the scope of benefit of ImPAT therapy as measured in the study — what degree of benefit in what percentage of those studied.
Chronic pain is a serious and widespread problem. According to the National Institutes of Health, approximately one in every four Americans has suffered from pain that lasts longer than 24 hours, and chronic pain is the most common cause of long-term disability. And, according to Senate testimony from the National Institute on Drug Abuse, “an estimated 2.1 million people in the United States suffer[ed] from substance use disorders related to prescription opioid pain relievers,” as of 2012.
This tells us that many people who are suffering from chronic pain may also be suffering from substance abuse disorders that make it difficult to treat their pain using conventional painkillers. Given that effect that both chronic pain and addiction can have on both health and quality of life, this is a significant problem. New treatment approaches that can begin to address this problem in a meaningful way are certainly important. That includes quantifying the benefits of new treatments, such as ImPAT, so that doctors and patients can have a better understanding of how much such approaches may be able to help.
Costs aren’t addressed. How much might one ImPAT session cost–given that patients may need as many as 10 sessions (or more) to see benefits? Is it possible that these sessions would be covered by insurance? It’s not clear. However, to the release’s credit, it does note that this treatment “has the potential to be easily and inexpensively adopted by addiction treatment centers and groups worldwide, through team members trained in standard psychological techniques.” That’s a positive point. But it doesn’t get at what the costs might be for patients. For example, does inexpensive adoption by treatment centers guarantee inexpensive treatment sessions?
The release addresses benefits in two ways: perceived effects, and how long they last. Here’s what it said about the beneficial effects: Patients “found that the intensity of their pain decreased, their ability to function increased, and their alcohol use went down, compared to [patients] who received a less-focused approach. However, the two groups had similar rates of drug use.” Kudos to the release for highlighting the lack of effect on rates of drug use.
However, it’s important to tell readers how much the patients’ pain decreased, alcohol use went down and ability to function increased. Are we talking about a statistically significant, but functionally irrelevant, margin? Or are we talking about a substantive difference? Readers want to know.
The release also notes that “Just 10 weekly sessions of [ImPAT] had an effect that lasted up to a year in 55 [patients] who took part.” That’s good to know — but that’s 55 patients out of how many? If you read the paper, you’ll see that the finding was true for 55 out of 65 patients who participated in ImPAT. That’s a strong result. But readers can’t know that if the release doesn’t tell them.
The release doesn’t address potential harms. But there don’t appear to be potential harms associated with ImPAT, certainly none that stand out relative to other behavioral interventions. So we’ll rate this not applicable.
The release makes a good effort at describing the study, though the language is a little confusing. Altogether, there were 129 patients in the study. The release tells us that half were in the ImPAT group, while the other half had conventional group therapy. The release describes ImPAT and offers an overview of patient demographics. The information is distributed throughout the release, which is what makes it confusing. However, it appears to be a good-faith attempt to describe the work openly for readers, so we’ll give it a Satisfactory rating.
No disease mongering here. The release does a good job of explaining why non-pharmaceutical interventions are needed to help patients with chronic pain who suffer from addiction.
The funding source is clearly identified. And while the release does not address conflicts of interest, there do not appear to be any conflicts of interest to address.
The release both addresses why some alternative treatment options are not available for chronic pain patients who suffer from addiction, and explicitly states that “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 non-addicted patients, including physical therapy, exercise and psychotherapy as well as antidepressant medications.”
The release notes that researchers have launched a larger, follow-up study of ImPAT, and that ImPAT could potentially be widely adopted. That seems to infer that ImPAT is not currently available outside of the treatment facility where the researchers work. However, it’s not clear whether that’s the case. Are other facilities offering this treatment technique, or something like it? Readers really have no way of knowing.
The release makes clear that the two treatment techniques that constitute ImPAT are rarely used jointly, but are both fairly common in pain treatment settings. However, as the release notes, pain treatment clinics and centers often decline to work with patients who have substance abuse problems.
Here’s the opening sentence: “It’s a Catch-22 with potentially deadly consequences: People trying to overcome addiction can’t get treatment for their pain, because the most powerful pain medicines also carry an addiction risk.”
We get that it’s a Catch-22. But what are the “potentially deadly consequences?” Failure to seek addiction treatment? Suicide? The release doesn’t tell us. It never explains what those “potentially deadly consequences” are. To be clear, it’s not that we doubt whether there might be deadly consequences–but if you’re going to spring a line like that on readers, you need to articulate exactly what you mean.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
Comments (2)
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Kara Gavin
August 9, 2016 at 3:25 pmAs the author of this press release, and a firm believer in HealthNewsReview.org’s mission, I appreciate the chance to be reviewed, and the comments above. I connected with the lead researcher and we’ve added a bit more to the release that we hope will address some of the issues identified by reviewers. Please see http://www.uofmhealth.org/news/archive/201607/treating-pain-without-feeding-addiction-study-shows-promise .
Matt Shipman
August 10, 2016 at 5:13 amKara -thanks for taking the review in the spirit in which it is intended! We all want to sharpen our skills in our chosen professions, and we all have an interest in getting clearer information to the public — and those are things we hope the reviews work toward. Thank you for being part of that.
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