Chronic Pain and Opioid Dependence Assessment and Treatment

描述（由申请人提供）：同时发生的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，他们通常不确定如何有效地评估和治疗POD。在过去的四年半里，巴里博士作为几项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。他在目前职位的限制下，在这一领域开展了一些临床研究，记录了阿片类激动剂项目中治疗POD的迫切需要以及引入这种治疗的可行性。为了实现他的职业目标，成为POD治疗开发和评估领域的独立临床研究人员，在未来五年内获得K23奖的支持，巴里博士计划进行指导临床研究，包括一系列第1阶段预试验和试验研究，包括随机临床试验，以开发和评估一种新的POD综合认知行为疗法（CBT）。为了收集可能有助于修改这种综合治疗的额外数据，他建议进行额外的研究，涉及MMT POD患者和治疗提供者的焦点小组，以及寻求MMT的POD患者的综合诊断评估（包括DSM-IV-TR轴I，II和III）。巴里博士的职业目标和拟议的研究计划与他的背景，培训和经验非常吻合，并使他能够将他对物质使用障碍，心理治疗发展以及文化和性别问题的兴趣编织在一起。巴里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，具体的先进统计方法和科学研究的道德行为方面的专业知识。如果被授予，K23将在他职业生涯的关键时刻提供工资支持，将他从相当大的项目总监责任中解放出来，并将使他能够将大约90%的精力投入到指导研究，教学活动和培训计划中，因此，为巴里博士提供必要的技能，以获得R 01资金，用于POD综合CBT的全面随机临床试验，并开始成功的独立研究生涯。鉴于POD在阿片类激动剂治疗、初级保健和专业疼痛医学环境中的高患病率，未经治疗或治疗不足的POD的有害后果，以及缺乏循证POD干预措施，开发有效的综合POD治疗将大大扩大和改善可用的药物滥用服务，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.