Psychosocial pain management to improve opioid use disorder treatment outcomes

摘要 开发新的策略来解决阿片类药物使用障碍（OUD）患者的疼痛， 改善大量慢性疼痛和OUD共病患者的结局。与国家 阿片类药物的流行是由于过度使用阿片类药物治疗疼痛而引起的，目前正在努力增加 获得药物辅助治疗（MAT），特别是药物丁丙诺啡。但不少 接受MAT治疗的人很早就离开了治疗，并继续与阿片类药物的使用作斗争，通常是在 在慢性疼痛合并症管理不善的背景下。帮助患者科普和适应的新策略 慢性疼痛是迫切需要的。对疼痛的心理社会干预在以下患者中有效： 慢性疼痛和物质使用障碍，但这些干预措施尚未在OUD中进行检查 接受MAT的人口。我们的团队收到了SAMHSA国家有针对性地应对阿片类药物危机的赠款， 帮助供应商在密歇根州东南部增加MAT的交付。提供替代疼痛治疗方案 具有成为提供有效MAT的重要组成部分的潜力。 本研究的目的是完善和调整社会心理疼痛管理干预（PPMI）， 通过电话为接受MAT的OUD患者提供，然后进行随机对照试验 在接受MAT的患者中进行干预，以改善OUD依从性以及疼痛和物质相关性 成果。该干预措施使用了适应性认知行为疼痛管理干预措施的要素 特别是对于接受MAT的OUD患者。这种新的干预措施将与增强的常规干预措施进行比较。 护理条件（EUC）。该研究将招募100名OUD和共病疼痛患者，在诊所接受MAT治疗 在密歇根州东南部具体目标是： R21具体目标1：使用定性患者访谈，采用基于电话的PPMI，并增强 常规护理（EUC）条件，以满足疼痛和OUD接受MAT的个人的需求。 R21特定目标2：通过对以下患者进行β测试，迭代完善PPMI和EUC（1） OUD和慢性疼痛和（2）专家意见。 R33具体目标1：进行一项试点RCT，比较基于电话的PPMI方法（n=50）与EUC （n=50），以评估随机分配至PPMI对MAT保留的影响（主要结局）。 R33具体目标2：确定PPMI对疼痛水平、疼痛相关功能和 阿片类药物使用频率（次要结局）。 本研究中产生的知识将对改善以下患者的结局具有重要意义： OUD和慢性疼痛，通过增加对有效的以患者为中心的心理社会策略的理解， 帮助患者更好地控制疼痛。最终，这一系列的研究有可能导致减少 在大量患有OUD和慢性疼痛的患者中的发病率和死亡率。

ABSTRACT Developing new strategies to address pain in patients with opioid use disorder (OUD) is critical to improving outcomes for the large population of patients with comorbid chronic pain and OUD. With the national opioid epidemic, which has been propelled by overuse of opioids for pain, efforts are underway to increase access to medication assisted treatment (MAT), especially with the medication buprenorphine. However, many individuals who receive MAT leave treatment early and continue to struggle with opioid use, often within the context of poorly-managed comorbid chronic pain. New strategies to help patients cope with and adapt to chronic pain are urgently needed. Psychosocial interventions for pain have been effective in patients with chronic pain and substance use disorders, but these interventions have not been examined in the OUD population receiving MAT. Our team received a SAMHSA State Targeted Response to Opioid Crisis grant to help providers increase delivery of MAT in Southeast Michigan. Providing alternative pain treatment options has the potential to be an important component delivering effective MAT. The purpose of this study is to refine and adapt a psychosocial pain management intervention (PPMI) to be delivered by telephone for patients with OUD receiving MAT and then to conduct a randomized controlled trial of the intervention in patients receiving MAT to improve OUD adherence and pain- and substance-related outcomes. The intervention uses elements of cognitive behavioral pain management interventions adapted specifically for patients with OUD receiving MAT. This new intervention will be compared to an enhanced usual care condition (EUC). The study will recruit 100 patients with OUD and comorbid pain receiving MAT in clinics in southeast Michigan. The specific aims are: R21 Specific Aim 1: Using qualitative patient interviews, adapt a telephone-based PPMI and enhanced usual care (EUC) condition to address the needs of individuals with pain and OUD receiving MAT. R21 Specific Aim 2: Iteratively refine the PPMI and EUC informed (1) by beta-testing with patients with OUD and chronic pain and (2) by expert opinion. R33 Specific Aim 1: Conduct a pilot RCT comparing a telephone-based PPMI approach (n=50) to EUC (n=50) to assess the impact of randomization to PPMI on retention to MAT (primary outcome). R33 Specific Aim 2: Determine the impact of the PPMI on pain level, pain-related functioning, and frequency of opioid use (secondary outcomes). Knowledge generated in this study will have important implications for improving outcomes for patients with OUD and chronic pain through increased understanding of effective patient-focused psychosocial strategies to help patients better manage pain. Ultimately, this line of research has the potential to lead to reductions in morbidity and mortality among the large number of patients suffering from OUD and chronic pain.