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)患者的疼痛问题至关重要 改善大量患有慢性疼痛和OUD的患者的预后。在全国范围内 阿片类药物流行，这是由过度使用阿片类药物治疗疼痛所推动的，正在努力增加 获得药物辅助治疗(MAT)，特别是丁丙诺啡药物。然而，许多人 接受MAT治疗的人很早就离开了，并继续与阿片类药物的使用作斗争，通常是在 管理不善的慢性疼痛的背景。帮助患者应对和适应的新策略 慢性疼痛是当务之急。对疼痛的心理社会干预对患有抑郁症的患者有效 慢性疼痛和物质使用障碍，但这些干预措施尚未在OUD进行检查 人口接待席。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拨款 帮助供应商增加密歇根州东南部的MAT交货量。提供替代的疼痛治疗方案 有潜力成为提供有效地垫的重要组成部分。 本研究的目的是改进和调整心理社会疼痛管理干预(PPMI)，使其成为 通过电话传递给接受MAT治疗的OUD患者，然后进行随机对照试验 对接受MAT的患者进行干预以改善OUD依从性以及疼痛和物质相关 结果。该干预使用了经调整的认知行为疼痛管理干预的要素 特别适用于接受尿垫治疗的患者。这一新的干预将被比作增强的惯常 护理条件(EUC)。这项研究将招募100名在临床上接受MAT治疗的疼痛患者。 在密歇根州东南部。具体目标是： R21具体目标1：使用定性的患者访谈，采用基于电话的PPMI和增强的 通常护理(EUC)条件，以满足有疼痛和接受垫子的个人的需求。 R21特定目标2：反复优化PPMI和EUC(1)，通过对患有以下疾病的患者进行Beta测试 OUD和慢性疼痛；(2)专家意见。 R33具体目标1：进行试点RCT，比较基于电话的PPMI方法(n=50)和EUC (n=50)评估PPMI随机化对MAT固位率的影响(主要结果)。 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(次要结果)。 这项研究中产生的知识将对改善患者的预后具有重要意义 通过增加对有效的以患者为中心的心理社会策略的理解来缓解和缓解慢性疼痛 帮助患者更好地控制疼痛。归根结底，这一系列研究有可能导致 大量患有慢性疼痛的患者的发病率和死亡率。

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.