INTEGRATED TREATMENT FOR VETERANS WITH CO-OCCURRING CHRONIC PAIN AND OPIOID USE DISORDER

项目描述：父母补助金（4UH 3DA 051241; PI Witkiewitz）的目的是进行一项 随机临床试验，以评估两种经验支持的干预措施的有效性：接受和 慢性疼痛的承诺疗法和基于正念的阿片类药物使用障碍复发预防 （OUD）。三个月后将通过检查疼痛干扰和阿片类药物使用结果来评估疗效 积极治疗，以及在6个月和12个月的随访。次要结果，包括抑郁，疼痛- 相关的恐惧和阿片类药物滥用风险也将在这些随访中进行评估。该研究还将 检查治疗机制中的治疗内变化之间的关系，包括疼痛接受， 参与基于价值观的行动，阿片类药物渴望，以及治疗后和随访的变化。数据 分析将采用创新的统计技术，以检查治疗组之间的差异， 结果测量使用混合效应模型，固定效应的治疗和随机效应的时间。 研究结果将通过开发独特的心理社会学， 以综合方式同时解决疼痛干扰和阿片类药物相关问题的治疗。 该补充材料的具体目标是：（1）确定土著居民中内化的耻辱感的社会心理相关因素， 慢性疼痛和OUD患者（n = 160）通过基于VA的联合治疗接受丁丙诺啡， 评估内化污名对患者治疗依从性的影响 （3）评估ACT+MBRP对减少内化污名的影响 慢性疼痛和OUD并存的患者中。这些具体目标将确定心理社会 内化耻辱的相关因素，评估内化耻辱对治疗依从性的影响， 研究综合治疗对减少内化的耻辱感的影响。

Project Description: The aims of the Parent Grant (4UH3DA051241; PI Witkiewitz) are to conduct a randomized clinical trial to assess the efficacy of two empirically supported interventions: Acceptance and Commitment Therapy for chronic pain and Mindfulness Based Relapse Prevention for opioid use disorder (OUD). Efficacy will be assessed by examining pain interference and opioid use outcomes after three months of active treatment, as well as at 6 and 12 month follow-ups. Secondary outcomes, including depression, pain- related fears, and opioid misuse risk, will also be assessed at these same follow-ups. The study will also examine the relation between within-treatment changes in treatment mechanisms, including pain acceptance, engagement in values-based action, and opioid craving, and changes at post- treatment and follow-up. Data analysis will implement innovative statistical techniques to examine differences between treatment groups on outcome measures using a mixed-effects model with fixed effects of treatment and random effects of time. The results will potential enhance current clinical practice guidelines by developing unique psychosocial treatment that simultaneously addresses pain interference and opioid-related problems in an integrated format. The specific aims of the supplement are to (1) Identify psychosocial correlates of internalized stigma among patients with chronic pain and OUD (n = 160) who are receiving buprenorphine through a VA-based co- occurring disorders clinic; (2) Assess the impact of internalized stigma on treatment adherence among patients with co-occurring chronic pain and OUD; (3) Assess the impact of ACT+MBRP on reducing internalized stigma among patients with co-occurring chronic pain and OUD. These specific aims will identify psychosocial correlates of internalized stigma, evaluate the effects of internalized stigma on treatment adherence, and examine the effects of integrated treatment on reducing internalized stigma.