{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T03:55:35Z","timestamp":1792295735339,"version":"4.4.0"},"reference-count":46,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>In recent years, there has been an unprecedented upsurge in opioid prescriptions for pain management. Consequently, the widespread availability of these medicines has led to an increase in misuse and abuse. This has led to a greater number of overdose-related deaths. The high prevalence of drug misuse was born of multiple and complex societal factors. However, from a medical perspective, critical contributors to the dire consequences of the crisis have been the need for chronic pain relief, as well as mental health issues within communities. Chronic pain coupled with psychological distress exacerbates patients\u2019 predicaments and thus further fuels the crisis. Anxiety and depression have bidirectional and complex relationships with pain. The somatic symptoms associated with anxiety potentially worsen pain, whilst pain emanating from a chronic condition worsens anxiety. The same relational dynamic applies to depression and pain. Thus, these psychopathological states may be major contributors to the opioid abuse epidemic. Thus, psychosocial management as a first-line treatment instead of starting with drug treatments seems an enlightened approach to this problem. Cognitive behavioral therapy (CBT) has been proven to be effective in managing specific symptoms associated with chronic pain. Similarly, patient education has been shown to be a viable alternative to drugs for certain aspects of chronic pain treatment. We consider that the opioid crisis could be addressed with a greater reliance and emphasis on non-pharmacological approaches to managing chronic pain patients. This mini-review examines non-pharmaceutical and monitoring-based interventions to reduce opioid misuse risk among adults prescribed opioids for chronic non-cancer pain. Studies were identified through PubMed\/MEDLINE, Scopus, and Google Scholar using terms related to chronic pain, prescription opioid misuse, opioid use disorder, cognitive behavioral therapy, patient education, prescription drug monitoring programs, digital health, telehealth, and non-pharmacological interventions. Studies were included if they focused on adults with chronic pain who were prescribed opioids or at risk of misuse, and evaluated interventions aimed at reducing unsafe opioid use, misuse risk, or opioid-related harm. Evidence was synthesized narratively to identify key intervention approaches, limitations, and clinical implications.<\/jats:p>","DOI":"10.3390\/jcm15114079","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T11:57:44Z","timestamp":1779710264000},"page":"4079","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exploring Non-Pharmacological Interventions as Part of Multimodal Management to Prevent Opioid Misuse in Adults Prescribed Opioids for Chronic Pain"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4461-3034","authenticated-orcid":false,"given":"Manar A.","family":"Alrashid","sequence":"first","affiliation":[{"name":"Department of Management, University of Liverpool, Liverpool L69 7ZX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya S.","family":"Zumot","sequence":"additional","affiliation":[{"name":"East Lancashire Hospitals Trust, Blackburn BB2 3HH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim","family":"Fredericks","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Royal College of Surgeons in Ireland, Al Muharraq 15503, Bahrain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1176\/appi.ajp.2015.15020262","article-title":"Prescription Opioid Misuse, Abuse, and Treatment in the United States: An Update","volume":"173","author":"Brady","year":"2016","journal-title":"Am. J. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1093\/ajhp\/zxy089","article-title":"The opioid crisis: Origins, trends, policies, and the roles of pharmacists","volume":"76","author":"Spivey","year":"2019","journal-title":"Am. J. Health-Syst. Pharm."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"89","DOI":"10.21106\/ijma.284","article-title":"Opioid Epidemic in the United States: Empirical Trends, and A Literature Review of Social Determinants and Epidemiological, Pain Management, and Treatment Patterns","volume":"8","author":"Singh","year":"2019","journal-title":"Int. J. MCH AIDS"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.bpobgyn.2022.07.003","article-title":"The opioid epidemic","volume":"85","author":"Cook","year":"2022","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"101200","DOI":"10.1016\/j.ehb.2022.101200","article-title":"Pain trends and pain growth disparities, 2009\u20132021","volume":"47","author":"Macchia","year":"2022","journal-title":"Econ. Hum. Biol."},{"key":"ref_6","unstructured":"Dydyk, A.M., and Conermann, T. (2024). Chronic Pain. StatPearls, StatPearls Publishing LLC."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1146\/annurev.med.49.1.123","article-title":"Chronic pain","volume":"49","author":"Russo","year":"1998","journal-title":"Annu. Rev. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s00296-016-3481-8","article-title":"An overview of treatment approaches for chronic pain management","volume":"37","author":"Duarte","year":"2017","journal-title":"Rheumatol. Int."},{"key":"ref_9","unstructured":"Phillips, J.K., Ford, M.A., Bonnie, R.J., Phillips, J.K., Ford, M.A., and Bonnie, R.J. (2017). Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use, National Academies Press."},{"key":"ref_10","first-page":"215","article-title":"Controlled substance abuse and illicit drug use in chronic pain patients: An evaluation of multiple variables","volume":"9","author":"Manchikanti","year":"2006","journal-title":"Pain Phys."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1146\/annurev-pharmtox-010617-052534","article-title":"The Opioid Epidemic: Crisis and Solutions","volume":"58","author":"Skolnick","year":"2018","journal-title":"Annu. Rev. Pharmacol. Toxicol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.drugalcdep.2015.01.027","article-title":"Trends in abuse and misuse of prescription opioids among older adults","volume":"149","author":"West","year":"2015","journal-title":"Drug Alcohol Depend."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.jpsychores.2016.09.006","article-title":"Is there a relationship between psychological stress or anxiety and chronic nonspecific neckarm pain in adults? A systematic review and meta-analysis","volume":"90","author":"Ortego","year":"2016","journal-title":"J. Psychosom. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1001\/archinte.163.20.2433","article-title":"Depression and pain comorbidity: A literature review","volume":"163","author":"Bair","year":"2003","journal-title":"Arch. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1097\/AJP.0000000000000603","article-title":"Depression Effects on Long-term Prescription Opioid Use, Abuse, and Addiction","volume":"34","author":"Sullivan","year":"2018","journal-title":"Clin. J. Pain"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e23859","DOI":"10.1097\/MD.0000000000023859","article-title":"Integrated cognitive behavioral therapy for chronic pain: An open-labeled prospective singlearm trial","volume":"100","author":"Taguchi","year":"2021","journal-title":"Medicine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s12954-017-0135-4","article-title":"The North American opioid epidemic: Current challenges and a call for treatment as prevention","volume":"14","author":"Vashishtha","year":"2017","journal-title":"Harm Reduct. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"139","DOI":"10.5114\/ait.2020.94756","article-title":"The opioid crisis in North America: Facts and future lessons for Europe","volume":"52","author":"Ayoo","year":"2020","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1111\/j.1465-3362.2010.00207.x","article-title":"Cognitive behaviour therapy (CBT) for the treatment of co-occurring depression and substance use: Current evidence and directions for future research","volume":"29","author":"Hides","year":"2010","journal-title":"Drug Alcohol Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1001\/jamainternmed.2018.0756","article-title":"Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults: A Systematic Review and Meta-analysis","volume":"178","author":"Niknejad","year":"2018","journal-title":"JAMA Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"74.e11","DOI":"10.1016\/j.amjmed.2012.07.005","article-title":"A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine","volume":"126","author":"Fiellin","year":"2013","journal-title":"Am. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jsat.2016.08.016","article-title":"Cognitive Behavioral Therapy Improves Treatment Outcomes for Prescription Opioid Users in Primary Care Buprenorphine Treatment","volume":"71","author":"Moore","year":"2016","journal-title":"J. Subst. Abus. Treat."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Alavi, S.M.A., Irani, R.D., Fattahi, P., and Pakseresht, S. (2023). Effects of brief cognitive behavioral therapy on mental health in substance-related disorder: A randomized controlled trial. BMC Psychiatry, 23.","DOI":"10.1186\/s12888-023-05413-4"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1037\/ccp0000044","article-title":"Meta-Analysis of Dropout From Cognitive Behavioral Therapy: Magnitude, Timing, and Moderators","volume":"83","author":"Fernandez","year":"2015","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1634\/theoncologist.2016-0266","article-title":"The Impact of an Educational Program on Patient Practices for Safe Use, Storage, and Disposal of Opioids at a Comprehensive Cancer Center","volume":"22","author":"Reddy","year":"2017","journal-title":"Oncologist"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1080\/15360288.2022.2049423","article-title":"The Effect of Patient Opioid Education on Opioid Use, Storage, and Disposal Patterns","volume":"36","author":"McElyea","year":"2022","journal-title":"J. Pain Palliat. Care Pharmacother."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1016\/j.joca.2022.08.001","article-title":"Chronic opioid use before and after exercise therapy and patient education among patients with knee or hip osteoarthritis","volume":"30","author":"Johansson","year":"2022","journal-title":"Osteoarthr. Cartil."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1377\/hlthaff.2019.00103","article-title":"Prescription Drug Monitoring Program Mandates: Impact on Opioid Prescribing and Related Hospital Use","volume":"38","author":"Wen","year":"2019","journal-title":"Health Aff."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1377\/hlthaff.2015.1673","article-title":"Prescription Drug Monitoring Programs Are Associated With Sustained Reductions In Opioid Prescribing By Physicians","volume":"35","author":"Bao","year":"2016","journal-title":"Health Aff."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1080\/08897077.2019.1695707","article-title":"Do prescription drug monitoring programs encourage prescription\u2014Or illicit\u2014Opioid abuse?","volume":"42","author":"Meadowcroft","year":"2021","journal-title":"Subst. Abus."},{"key":"ref_31","unstructured":"Duff, J., Davis-Castro, C., Cornell, A., and Romero, P. (2021). Consumption of Prescription Opioids for Pain: A Comparison of Opioid Use in the United States and Other Countries, Congressional Research Service."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Garcia-Orjuela, M.G., Alarcon-Franco, L., Sanchez-Fernandez, J.C., Agudelo, Y., and Zuluaga, A.F. (2016). Dependence to legally prescribed opioid analgesics in a university hospital in MedellinColombia: An observational study. BMC Pharmacol. Toxicol., 17.","DOI":"10.1186\/s40360-016-0087-4"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1176\/appi.prcp.20180009","article-title":"World opioid and substance use epidemic: A Latin American perspective","volume":"1","year":"2019","journal-title":"Psychiatr. Res. Clin. Pract."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"102616","DOI":"10.1016\/j.drugpo.2019.102616","article-title":"Opioid-related deaths in Europe: Strategies for a comprehensive approach to address a major public health concern","volume":"76","author":"Alho","year":"2020","journal-title":"Int. J. Drug Policy"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1111\/add.15839","article-title":"What lessons from Europe\u2019s experience could be applied in the United States in response to the opioid addiction and overdose crisis?","volume":"117","author":"Pierce","year":"2022","journal-title":"Addiction"},{"key":"ref_36","first-page":"1","article-title":"Opioids in middle eastern populations","volume":"11","author":"Silbermann","year":"2010","journal-title":"Asian Pac. J. Cancer Prev. APJCP"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"103617","DOI":"10.1016\/j.drugpo.2022.103617","article-title":"Medication for opioid use disorder in the Arab World: A systematic review","volume":"102","author":"Alawa","year":"2022","journal-title":"Int. J. Drug Policy"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"150","DOI":"10.2471\/BLT.12.111815","article-title":"Delivery models of opioid agonist maintenance treatment in South Asia: A good beginning","volume":"91","author":"Rao","year":"2013","journal-title":"Bull. World Health Organ."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Westermeyer, J. (1983). Treatment of opiate addiction in Asia. Research Advances in Alcohol and Drug Problems, Springer.","DOI":"10.1007\/978-1-4613-3626-6_11"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Alhassan, J.A.K. (2022). Where is the pain? A qualitative analysis of Ghana\u2019s opioid (tramadol) \u2018crisis\u2019 and youth perspectives. PLoS Glob. Public Health, 2.","DOI":"10.1371\/journal.pgph.0001045"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e074235","DOI":"10.1136\/bmjopen-2023-074235","article-title":"Psychosocial safety climate (PSC) and working conditions, predictors of mental health and antidepressant and opioid use in Australia: A study protocol for longitudinal data linkage","volume":"13","author":"Crispin","year":"2023","journal-title":"BMJ Open"},{"key":"ref_42","first-page":"6872","article-title":"Understanding the dynamics of more restrictive medicines policy: A case study of codeine up-scheduling in Australia","volume":"12","author":"Chiu","year":"2022","journal-title":"Int. J. Health Policy Manag."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"108837","DOI":"10.1016\/j.drugalcdep.2021.108837","article-title":"The impact of Codeine upscheduling on overdoses, emergency department presentations and mortality in Victoria, Australia","volume":"226","author":"Bishop","year":"2021","journal-title":"Drug Alcohol Depend."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/dar.12400","article-title":"Findings and lessons learnt from implementing Australia\u2019s First Health Service based take-home Naloxone Program","volume":"37","author":"Chronister","year":"2016","journal-title":"Drug Alcohol Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1146\/annurev-clinpsy-080921-072750","article-title":"Culturally responsive cognitive behavioral therapy for ethnically diverse populations","volume":"19","author":"Huey","year":"2023","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"15","DOI":"10.5498\/wjp.v13.i1.15","article-title":"Evaluation of a culturally adapted cognitive behavior therapy-based, third-wave therapy manual","volume":"13","author":"Phiri","year":"2023","journal-title":"World J. Psychiatry"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4079\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T12:21:31Z","timestamp":1779711691000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4079"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":46,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114079"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114079","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]}}}