Integrated Treatment for Veterans with Co-Occurring Chronic Pain and Opioid Use Disorder

针对同时发生慢性疼痛和阿片类药物使用障碍的退伍军人的综合治疗

• 批准号: 10250682
• 负责人: KEVIN E VOWLES
• 金额: $ 55.82万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10250682
• 关键词: Address; Aftercare; Agreement; Alcohol or Other Drugs use; Behavior Therapy; Buprenorphine; Case Report Form; Clinic; Clinical; Clinical Protocols; Common Data Element; Education; Evidence based treatment; Fright; Goals; Health; Human; Human Resources; Individual; Institutes; Intervention; Knowledge; Mental Depression; Military Personnel; Mindfulness Training; Modeling; Morbidity - disease rate; Opiate Addiction; Opioid; Outcome; Pain; Pain intensity; Pain interference; Pain management; Participant; Patient Self-Report; Patients; Phase; Physicians; Pilot Projects; Preventive Intervention; Procedures; Process; Psychology; Psychosocial Assessment and Care; Public Health; Randomized; Randomized Clinical Trials; Reporting; Research; Risk; Specific qualifier value; Testing; Therapeutic; Training; Treatment outcome; United States; United States Department of Veterans Affairs; United States National Institutes of Health; Urine; Veterans; Work; active method; base; buprenorphine treatment; chronic pain; chronic pain patient; clinical care; clinical research site; clinically significant; comorbidity; cost; craving; design; disorder later incidence prevention; dual diagnosis; effectiveness research; efficacy testing; follow-up; innovation; mindfulness; mortality; multi-site trial; opioid misuse; opioid use; opioid use disorder; pain reduction; prescription opioid; prescription opioid misuse; primary outcome; programs; psychosocial; recruit; secondary outcome; substance misuse; substance use prevention

PROJECT SUMMARY Chronic pain is common, costly, and debilitating. Opioid prescription in the treatment of chronic pain is frequent and carries a consequent risk of poor treatment outcome, as well as higher morbidity and mortality in a clinically significant number of patients, particularly those who meet criteria for opioid dependence. Despite the alarming increases in prescription opiate misuse and opioid use disorder (OUD) nationally in the United States, there are few treatment options available that target both pain-related interference and OUD among patients with chronic pain. In military veterans, this issue is of particular importance as numerous reports indicate frequent use of opioids in the treatment of chronic pain, as well as increasing opioid-related problems. To date, there are no evidenced-based treatment options which aim to both reduce pain interference simultaneously addressing problematic opioid use. The overall aim of the present study will be to determine the efficacy of an integrated psychosocial treatment in veterans with chronic pain, who are taking buprenorphine for the treatment of OUD. To examine this aim, we will utilize a randomized design to assess the efficacy of two empirically supported interventions: Acceptance and Commitment Therapy for chronic pain and Mindfulness Based Relapse Prevention for substance use and misuse. Efficacy will be assessed by examining pain interference and substance use outcome 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. The results of this study will directly inform treatment of chronic pain patients and represents a significant advance in the growing and understudied problem of OUD among chronic pain patients. In addition to addressing the question of whether the treatment is feasible, it will further examine issues of treatment mechanisms to better inform the provision of treatment.

项目摘要 慢性疼痛很常见，昂贵且令人衰弱。慢性治疗中的阿片类药物处方 疼痛经常出现，因此具有不良治疗结果的风险，并且更高 临床上大量的患者，尤其是那些相遇的患者的发病率和死亡率 阿片类药物依赖性的标准。尽管处方鸦片滥用和 在美国全国范围内阿片类药物使用障碍（OUD），几乎没有治疗选择 可在患有慢性疼痛的患者中靶向与疼痛相关的干扰和OUD。 在退伍军人中，这个问题尤其重要，因为许多报告表明频繁 使用阿片类药物治疗慢性疼痛，以及增加与阿片类药物有关的问题。到 日期，没有基于证据的治疗方案，旨在减轻疼痛 干涉同时解决有问题的阿片类药物使用。现在的总体目的 研究将是确定综合社会心理治疗在退伍军人中的功效 慢性疼痛，他们正在服用丁丙诺啡治疗OUD。为了检查这个目标，我们 将利用随机设计来评估两种经验支持的干预措施的功效： 接受和承诺治疗慢性疼痛和基于正念的复发 预防吸毒和滥用。将通过检查疼痛来评估功效 三个月的主动治疗后的干扰和物质使用结果以及6 和12个月的随访。次要结果，包括抑郁症，与疼痛有关的恐惧和 阿片类药物滥用风险也将在这些相同的随访中进行评估。该研究还将检查 治疗机制的治疗内部变化之间的关系，包括疼痛 接受，基于价值的行动的参与以及阿片类药物的渴望以及后的变化 治疗和随访。这项研究的结果将直接告知慢性疼痛的治疗 患者，代表了越来越多的OUD问题的重大进展 在慢性疼痛患者中。除了解决治疗是否是 可行的，它将进一步研究治疗机制的问题，以更好地告知 治疗。