This study explored mediating pathways, moderating factors, and moderated mediation effects of a web-based, cognitive behavioral therapy (CBT) intervention for chronic pain patients with aberrant drug-related behavior (ADRB). In a 2-arm RCT, patients with chronic pain who screened positive for ADRB received treatment-as-usual (TAU, n = 55) or TAU plus a 12-week, web-based CBT intervention (n = 55). Assessments were conducted at weeks 4, 8, and 12, and at 1- and 3-months post intervention. Web-CBT significantly reduced pain catastrophizing, which, in turn, reduced pain interference and pain severity via a pathway of pain catastrophizing. Web-CBT also significantly reduced ADRB both directly and indirectly by reducing pain catastrophizing. For pain interference and pain severity, web-CBT was more effective than TAU for younger patients (≤ age 50). For pain severity, web-CBT was more effective for both younger patients (≤ age 50), and those with a lifetime substance use disorder. Findings suggest that web-CBT’s positive impact on pain outcomes and ADRB are mediated by its effect on pain catastrophizing, and its treatment effects may be most robust for younger patients and those with histories of substance dependence.

本研究探讨了基于网络的认知行为疗法 (CBT) 干预对具有异常药物相关行为 (ADRB) 的慢性疼痛患者的中介途径、调节因素和中介作用。在一项 2 组 RCT 中，ADRB 筛查呈阳性的慢性疼痛患者接受了常规治疗（TAU，n = 55）或 TAU 加上 12 周的基于网络的 CBT 干预（n = 55）。在第 4、8 和 12 周以及干预后 1 和 3 个月进行评估。Web-CBT 显着减少了疼痛灾难化，这反过来又通过疼痛灾难化途径减少了疼痛干扰和疼痛严重程度。Web-CBT 还通过减少疼痛灾难化直接和间接显着降低 ADRB。对于疼痛干扰和疼痛严重程度，对于年轻患者（≤ 50 岁），网络 CBT 比 TAU 更有效。对于疼痛严重程度，网络 CBT 对年轻患者（≤ 50 岁）和终生物质使用障碍患者更有效。研究结果表明，网络 CBT 对疼痛结果和 ADRB 的积极影响是由其对疼痛灾难化的影响介导的，其治疗效果可能对年轻患者和有物质依赖史的患者最有效。