Chronic Pain and Opioid Dependence Assessment and Treatment

描述（由申请人提供）：并发慢性疼痛和阿片类药物依赖（POD）是阿片类药物激动剂治疗、初级保健和专业疼痛药物治疗提供者面临的最具挑战性的临床问题之一，他们往往不确定如何有效地评估和治疗POD。在过去的四年半里，Barry博士作为NIDA资助的阿片类药物依赖研究的项目主任，越来越意识到并对治疗POD患者的临床挑战感兴趣。在他目前职位的限制下，他在这一领域开展了一些临床研究，这些研究证明了在阿片类激动剂项目中解决POD治疗的迫切需要以及引入这种治疗的可行性。为了实现他成为POD治疗开发和评估领域独立临床研究人员的职业目标，在未来五年内获得K23奖的支持，Barry博士计划进行包括一系列阶段1预试点和试点研究的指导临床研究，包括一项随机临床试验，以开发和评估一种新的综合认知行为疗法（CBT）。为了收集更多的数据，可能有助于修改这种综合治疗，他建议进行更多的研究，包括MMT POD患者和治疗提供者的焦点小组，并对寻求MMT的POD患者进行全面的诊断评估（包括DSM-IV-TR轴I， II和III）。Barry博士的职业目标和提出的研究计划与他的背景、培训和经验非常吻合，使他能够将他在物质使用障碍、心理治疗发展、文化和性别问题方面的兴趣结合起来。Barry博士还计划参加各种研讨会和临床培训，旨在提高他在慢性疼痛评估和治疗、心理治疗发展、定性研究方法、特定高级统计方法和科学研究道德行为方面的专业知识。如果获得该奖项，K23将在他职业生涯的关键时刻提供工资支持，使他从繁重的项目主管职责中解脱出来，并允许他将大约90%的精力投入到指导研究、教学活动和培训计划中，从而为Barry博士提供必要的技能，以获得R01资助，进行全面随机临床试验，并启动成功的独立研究生涯。鉴于阿片类药物激动剂治疗、初级保健和专业疼痛医学环境中POD的高患病率，未经治疗或治疗不足的POD的有害后果，以及缺乏循证的POD干预措施，开发有效的综合POD治疗将极大地扩展和改善现有的药物滥用服务，并为我们的社会带来显著的健康和经济效益。

DESCRIPTION (provided by applicant): Co-occurring chronic pain and opioid dependence (POD) is one of the most challenging clinical problems facing opioid agonist treatment, primary care, and specialty pain medicine treatment providers, who are often unsure how to effectively evaluate and treat POD. Through his work as Project Director for several NIDA funded studies of opioid dependence over the last four and a half years, Dr. Barry became increasingly aware of and interested in the clinical challenges of treating patients with POD. He has, within the constraints of his current position, initiated some clinical research in this area, which documents the urgent need for treatment addressing POD in opioid agonist programs and the feasibility of introducing such a treatment. To achieve his career goal of becoming an independent clinical researcher in the area of POD treatment development and evaluation, supported by a K23 award over the next five years, Dr. Barry plans to conduct mentored clinical research involving a series of Stage 1 pre-pilot and pilot studies, including a randomized clinical trial, to develop and evaluate a novel integrated cognitive-behavioral therapy (CBT) for POD. In order to gather additional data that may help to inform modifications of this integrated treatment, he proposes to conduct additional studies, involving focus groups with MMT POD patients and treatment providers and comprehensive diagnostic assessment (including DSM-IV-TR Axes I, II, and III) with POD patients seeking MMT. Dr. Barry's career goal and proposed research plan fit well with his background, training and experiences and allow him to weave together his interests in substance use disorders, psychotherapy development, and cultural and gender issues. Dr Barry also plans to participate in a variety of seminars and clinical trainings aimed at increasing his expertise in chronic pain assessment and treatment, psychotherapy development, qualitative research methods, specific advanced statistical approaches, and ethical conduct of scientific research. If awarded, the K23 would provide salary support at a critical juncture in his career, free him up from his considerable Project Director responsibilities, and would allow him to devote approximately 90% of his effort toward a plan of mentored research, didactic activities, and training, thus, equipping Dr. Barry with the necessary skills to obtain R01 funding for a full-scale randomized clinical trial of integrated CBT for POD and to launch a successful independent research career. Given the high prevalence of POD in opioid agonist treatment, primary care, and specialty pain medicine settings, the pernicious consequences of untreated or under-treated POD, and the absence of evidence-based POD interventions, the development of an effective integrated POD treatment would greatly expand and improve available substance abuse services and lead to significant health and economic benefits to our society.