Psychosocial pain management during addictions treatment to improve outcomes

描述(由申请人提供)：患有物质使用障碍(SUDS)的个人的慢性疼痛是一个常见且极其重要的问题，很少得到适当的处理。在接受SUD治疗的患者中，慢性疼痛的估计比率高达60%，许多患者报告在治疗期间持续且显著的疼痛。对于那些有肥皂泡的人来说，疼痛的治疗是复杂的，因为许多处方止痛药可能会被滥用和转移。此外，最近的证据表明，未经治疗的疼痛可能会削弱肥皂泡标准治疗的有效性。一个重要的潜在策略是使用认知行为疗法(CBT)来控制疼痛和减少物质的使用/误用。心理社会干预措施，如CBT，已经在患有广泛疼痛相关问题的人中证明了减轻疼痛和改善功能的有效性，但尚未在患有肥胖症的人中进行评估。因此，SUD治疗提供者没有成功的和有经验支持的方法来治疗大量也患有SUD的慢性疼痛患者。这项拟议的研究是一项基于组的干预措施的随机对照疗效试验，该干预措施将CBT用于疼痛和肥胖症，与支持性心理教育对照组(SPC)相比，在SUD治疗合并慢性疼痛的患者样本中进行比较。共有452名目前疼痛评级为中度或以上的患者(226名男性和226名女性)将从一家大型住宅SUD治疗机构招募。这些参与者将被随机分配到为期4周(8节)的综合CBT止痛和肥皂水组或4周(8节)的SPC组。所有参与者将在干预完成后立即(约1个月)以及干预后3个月、6个月和12个月重新评估。主要的具体目标将侧重于疼痛(水平、耐受性和与疼痛有关的残疾)和物质使用(药物、酒精和阿片类药物滥用的频率)的结果。二次分析将探索：1)干预过程中疼痛的变化是否中介CBT对随后的药物使用/误用的影响；2)CBT干预的其他假想的作用机制；以及3)干预对艾滋病毒危险行为和抑郁症状的影响。混合模型回归分析将用于每个性别内的所有主要目标，以估计随着时间的推移结果变化的组间差异。目前，治疗提供者缺乏循证干预措施来解决肥皂泡患者的疼痛问题。改善肥皂泡患者的疼痛治疗不仅会对个人的疼痛产生广泛的影响，还会对他们的物质使用和生活质量产生广泛的影响。在拟议的研究中产生的知识可能会对许多不同医疗保健环境中的疼痛和肥皂泡患者的护理产生广泛的影响。

DESCRIPTION (provided by applicant): Chronic pain among individuals with Substance Use Disorders (SUDs) is a common and critically important problem that is rarely managed appropriately. The estimated rates of chronic pain in patients who are in SUD treatment are as high as 60 percent, with many patients reporting long-lasting and significant pain during treatment. The treatment of pain is complicated in those with SUDs because of the potential for abuse and diversion of many prescription pain medications. Furthermore, recent evidence suggests that untreated pain may undermine the effectiveness of standard treatments for SUDs. An important potential strategy is the use of cognitive behavioral therapy (CBT) to both manage pain and decrease substance use/misuse. Psychosocial interventions such as CBT have demonstrated efficacy for reducing pain and improving functioning in persons with a broad spectrum of pain-related problems, but have not been evaluated in those with SUDs. Thus, SUD treatment providers are left without successful and empirically-supported methods for treating the large number of patients with chronic pain who also have SUDs. The proposed study is a randomized controlled efficacy trial of a group-based intervention that integrates CBT for pain and SUDs compared to a Supportive Psychoeducation Control (SPC) group in a sample of patients in SUD treatment with co-occurring chronic pain. A total of 452 patients (226 male and 226 female) with current pain rated as moderate or greater will be recruited from a large residential SUD treatment facility. These participants will be randomly assigned to either a 4-week (8-session) group of integrated CBT for pain and SUDs or a 4-week (8-session) SPC group. All participants will be re-assessed immediately post-intervention completion (around 1-month) and at 3-, 6-, and 12- months after the intervention. The primary specific aims will focus on pain (level, tolerance and pain-related disability) and substance use (frequency of drug, alcohol and opioid medication misuse) outcomes. Secondary analyses will explore: 1) whether change in pain during the intervention mediates the effect of CBT on subsequent substance use/misuse; 2) other hypothesized mechanisms of action for the CBT intervention; and 3) the impact of the intervention on HIV risk behaviors and depressive symptoms. Mixed model regression analyses will be used for all primary aims, within each gender, to estimate between-group differences in changes in outcomes over time. Currently, treatment providers lack evidence-based interventions to address pain in individuals with SUDs. Improving the treatment of pain in patients with SUDs could have a wide-ranging impact not only on individuals' pain, but also on their substance use and quality of life. Knowledge generated in the proposed study is likely to have broad implications for the care of patients with pain and SUDs in many different healthcare settings.