# Telehealth CBT to increase engagement in pain treatment among Veterans using prescription opioids

> **NIH VA I01** · VETERANS AFFAIRS, UNITED STATES DEPARTMENT OF · 2022 · —

## Abstract

Background: Chronic pain and negative consequences of long-term opioid therapy are related public health
concerns associated with significant functional impairment, high psychiatric comorbidity, and premature
mortality, particularly among Veterans. Clinical Practice Guidelines for opioid prescribing and pain
management recommend using non-pharmacological approaches as first-line treatments. Psychosocial
interventions (e.g., cognitive-behavioral therapy) have strong evidence supporting their ability to improve pain
outcomes. Patient beliefs about the stigma associated with psychological interventions, opioid analgesics,
ability of psychosocial intervention to improve pain among others can greatly interfere with the patients’ ability
to initiate and maintain engagement in psychosocial interventions and other non-pharmacological approaches.
Significance/Impact: Without a concerted effort at affecting beliefs that impede engagement in treatment,
Veterans who may benefit from the treatment, will not receive it. This can result in continued risk for negative
consequences associated with long-term opioid therapy and inadequate pain management. Cognitive-
Behavioral Therapy for Treatment Seeking (CBT-TS) is an evidence-based intervention that directly intervenes
on beliefs that act as barriers to treatment initiation and retention. By intervening on these beliefs, this study
has the potential to improve engagement in psychosocial pain interventions and other non-pharmacological
pain treatments, which will improve pain-related interference and functioning and reduce reliance on opioid
analgesics. This study addresses VHA/VA Veteran care priorities including opioid use, pain management, and
access and directly addresses priorities of the HSR&D Targeted Solicitation for Service Directed Research on
Opioid Safety and Opioid Use Disorder.
Innovation: The proposed study is the first application of CBT-TS for Veterans with chronic pain who are
receiving opioid analgesics–a notably high-risk, treatment-resistant population. This is the first study to directly
intervene on thoughts about psychosocial interventions.
Specific Aims: The specific aims are to: test the effects of CBT-TS to increase initiation of psychosocial
interventions for pain among Veterans receiving opioid analgesics for chronic pain (Aim 1), test the effects of
CBT-TS to increase the retention in psychosocial interventions for pain among Veterans receiving opioid
analgesics for chronic pain (Aim 2), and evaluate the effects of CBT-TS in improving pain and substance use
outcomes among Veterans receiving opioid analgesics for chronic pain (Aim 3). We will also test the effects of
CBT-TS on the initiation of and retention to other non-pharmacological pain treatments (Exploratory Aim).
Methodology: Participants (N = 300) will be randomized to either the CBT-TS condition or an education
control condition. Participants in both conditions will complete assessments on pain, treatment engagement,
and op...

## Key facts

- **NIH application ID:** 10424658
- **Project number:** 1I01HX003409-01A1
- **Recipient organization:** VETERANS AFFAIRS, UNITED STATES DEPARTMENT OF
- **Principal Investigator:** LISHAM ASHRAFIOUN
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-05-01 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10424658

## Citation

> US National Institutes of Health, RePORTER application 10424658, Telehealth CBT to increase engagement in pain treatment among Veterans using prescription opioids (1I01HX003409-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10424658. Licensed CC0.

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