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

项目描述：家长基金(4UH3DA051241；Pi Witkiewitz)的目标是开展一项 评估两种经验性干预的有效性的随机临床试验：接受和 承诺疗法预防阿片类药物使用障碍的慢性疼痛和正念 (有声)。三个月后将通过检查疼痛干预和阿片类药物的使用结果来评估疗效 积极治疗，以及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后续行动中进行评估。这项研究还将 检查治疗机制内的变化之间的关系，包括疼痛接受， 参与基于价值观的行动，阿片类药物的渴望，以及治疗后和随访时的变化。数据 分析将实施创新的统计技术，以检查治疗组之间的差异 结果测量采用具有固定治疗效果和随机时间效果的混合效果模型。 这一结果将通过发展独特的心理社会，潜在地加强当前的临床实践指南。 同时以综合形式解决疼痛干扰和阿片类药物相关问题的治疗。 补充资料的具体目的是：(1)在以下人群中确定内化污名的心理社会相关因素 160例慢性疼痛患者通过以VA为基础的联合疗法接受丁丙诺啡治疗 (2)评估内在化污名对患者治疗依从性的影响 (3)评估ACT MBRP对减少内在化污名的影响 在慢性疼痛和OUD并存的患者中。这些特定的目标将确定心理社会 内化污名的相关性，评估内化污名对治疗依从性的影响，以及 检查综合治疗在减少内在化污名方面的效果。

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.