Integrated Care for Chronic Pain and Opioid Use Disorder: The IMPOWR Research Center at Montefiore/Einstein (IMPOWR-ME)

摘要 慢性疼痛(CP)和阿片类药物使用障碍(OUD)是美国发病率和死亡率的主要原因 各州。尽管普遍存在合并症，但人们普遍缺乏可获得的综合治疗。 在需要的时候。对于在资源不足的地方生活和寻求护理的黑人和西班牙裔个人来说，情况尤其如此 像纽约州布朗克斯县这样的环境，美国最贫穷和种族最多样化的县之一，在 对Hear倡议的回应：慢性疼痛的综合管理和整体康复 (IMPOWR)RFA-DA-21-030，该提案的总体目标是在以下位置创建IMPOWR研究中心 蒙特菲奥雷/爱因斯坦(“IMPOWR-ME”)，在纽约州布朗克斯县的高影响力县。IMPOWR-ME是一种协同 多学科研究中心，利用CP和OUD的卓越研究基础设施 与CP和OUD患者、倡导者、政策制定者和付款人以及健康方面的现有关系 系统利益相关者。IMPOWR-ME的目标是：1)创建强大和可持续的研究 严格测试和传播基于综合且经济高效的证据的基础设施 为患有CP和OUD的人提供实践；2)与具有CP、OUD或 和不同的利益相关者在研究的所有阶段；以及3)提供机会 多学科早期调查人员将成为专注于CP和 奥德。提出了三项创新的混合类型1有效性实施试验，以严格审查 多模式循证实践在不同卫生保健环境和并存人群中的应用 CP和OUD。具体地说，我们建议：1)在美沙酮进行现场瑜伽和物理治疗的三臂试验 阿片类药物治疗计划，2)2x2因素试验，以测试接受和承诺治疗和护理 管理智能手机应用程序，用于基于丁丙诺啡治疗的初级保健个人，以及3)双臂 为住院患者测试丁丙诺啡微量诱导与标准诱导的试验。所有项目的参与者 项目有CP和OUD或阿片类药物滥用，每个项目的具体目标将检查CP、OUD、 实施和成本效益结果；更多以患者为中心的结果将由 有生活经验的人。所有这三个项目都改善了对黑人和西班牙裔个人的护理 通过将CP和OUD的综合治疗带给他们，资源不足的环境，干预措施 传播和可持续性的潜力很大。创新的先导研究项目实现了双重目标 促进利益相关者驱动的研究和培训早期和新的调查人员。一支不同寻常的球队 研究人员和临床专家专注于CP和OUD，这是与 利益相关者和有生活经验的人，以及高影响力的人群使蒙特菲奥里-爱因斯坦成为 作为IMPOWR研究中心的理想地点。

ABSTRACT Chronic pain (CP) and opioid use disorder (OUD) are leading causes of morbidity and mortality in the United States. Despite being commonly comorbid, there is a striking lack of integrated treatments accessible to people in need. This is particularly true for Black and Hispanic individuals living and seeking care in under-resourced settings like The Bronx, NY, one of the poorest and most racially diverse counties in the U.S. Submitted in response to the HEAL Initiative: Integrative Management of Chronic Pain and OUD for Whole Recovery (IMPOWR) RFA-DA-21-030, the overall goal of this proposal is to create the IMPOWR Research Center at Montefiore/Einstein (“IMPOWR-ME”), in the high-impact county of The Bronx NY. IMPOWR-ME is a synergistic multidisciplinary research center that leverages exceptional research infrastructure in CP and OUD and existing relationships with people living with CP and OUD, advocates, policymakers and payers, and health system stakeholders. The aims of IMPOWR-ME are to: 1) create a robust and sustainable research infrastructure to rigorously test and disseminate integrated and cost-effective evidence-based practices for people with CP and OUD; 2) partner with people with lived experience with CP, OUD, or both, and diverse stakeholders in all stages of the research; and 3) provide opportunities for multidisciplinary early stage investigators to become independent researchers focusing on CP and OUD. Three innovative hybrid type 1 effectiveness-implementation trials are proposed to rigorously examine multi-modal evidence-based practices in diverse health care settings and populations of people with comorbid CP and OUD. Specifically, we propose: 1) a three-arm trial of yoga and physical therapy onsite at methadone opioid treatment programs, 2) a 2x2 factorial trial to test Acceptance and Commitment Therapy and a care management smartphone app for individuals in primary-care based buprenorphine treatment, and 3) a two-arm trial to test microdosing vs. standard induction of buprenorphine for hospitalized patients. Participants in all projects have both CP and OUD or opioid misuse, and specific aims for each project will examine CP, OUD, implementation, and cost-effectiveness outcomes; additional patient-centered outcomes will be driven by people with lived experience. All three projects improve access to care for Black and Hispanic individuals in under-resourced settings by bringing integrated treatment of CP and OUD to them, and the interventions have high potential for dissemination and sustainability. An innovative program for pilot studies achieves a dual aim of catalyzing stakeholder-driven research and training early stage and new investigators. An exceptional team of investigators and clinical experts focused on CP and OUD, a longstanding history of collaboration with stakeholders and people with lived experience, and a high-impact population make Montefiore-Einstein an ideal site for an IMPOWR research center.