Psychosocial pain management during addictions treatment to improve outcomes

成瘾治疗期间的心理社会疼痛管理以改善结果

• 批准号: 8628093
• 负责人: MARK A. ILGEN
• 金额: $ 50.45万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8628093
• 关键词: Address; Aftercare; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Analgesics; Behavioral; Cognitive; Cognitive Therapy; Control Groups; Data; Drug usage; Effectiveness; Effectiveness of Interventions; Evidence based intervention; Female; Frequencies; Gender; Goals; HIV risk; Health; Health Personnel; Healthcare; Illicit Drugs; Individual; Intervention; Knowledge; Left; Mediating; Mental Depression; Methods; Modeling; Motivation; Opiates; Opioid; Outcome; Pain; Pain Threshold; Pain management; Participant; Patient Care; Patients; Persons; Pharmaceutical Preparations; Population; Protocols documentation; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Regression Analysis; Reporting; Residential Treatment; Risk Behaviors; Sampling; Self Efficacy; Staging; Substance Use Disorder; Testing; Time; Woman; addiction; alcohol use disorder; base; chronic pain; coping; depressive symptoms; design; disability; drug abuser; effective intervention; efficacy testing; efficacy trial; evidence base; follow-up; improved; improved functioning; innovation; intervention effect; male; men; patient population; post intervention; psychoeducation; psychosocial; public health relevance; standard care; treatment effect; treatment program

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.

描述（由申请人提供）：物质使用障碍（SUD）患者的慢性疼痛是一种常见且至关重要的问题，很少得到适当的管理。接受SUD治疗的患者的慢性疼痛率估计高达60%，许多患者在治疗期间报告了持久和显著的疼痛。SUD患者的疼痛治疗很复杂，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破坏SUD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）来管理疼痛和减少物质使用/滥用。心理社会干预（如CBT）已证明对减轻疼痛和改善具有广泛疼痛相关问题的人的功能有效，但尚未在SUD患者中进行评估。因此，SUD治疗提供者没有成功的和医学支持的方法来治疗大量患有慢性疼痛的患者，这些患者也患有SUD。拟议的研究是一项基于组的干预的随机对照有效性试验，该干预将疼痛和SUD的CBT与支持性心理教育对照（SPC）组进行了比较，并在SUD治疗中合并慢性疼痛的患者样本中进行了比较。将从一家大型住宅SUD治疗机构招募总计452名当前疼痛评定为中度或以上的患者（226名男性和226名女性）。这些受试者将被随机分配到为期4周（8次）的疼痛和SUD综合CBT组或为期4周（8次）的SPC组。所有受试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个月进行重新评估。主要具体目标将侧重于疼痛（水平，耐受性和疼痛相关的残疾）和物质使用（药物，酒精和阿片类药物滥用的频率）结果。次要分析将探索：1）干预期间疼痛的变化是否介导CBT对随后物质使用/滥用的影响; 2）CBT干预的其他假设作用机制; 3）干预对艾滋病毒风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的，以估计随时间推移结局变化的组间差异。目前，治疗提供者缺乏基于证据的干预措施来解决SUD患者的疼痛。改善SUD患者的疼痛治疗不仅对个人的疼痛，而且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对许多不同医疗机构中疼痛和SUD患者的护理产生广泛的影响。